Provider Demographics
NPI:1003809773
Name:PENG, YAOHSIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAOHSIEN
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GALLIVAN LN
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1208
Mailing Address - Country:US
Mailing Address - Phone:860-367-0688
Mailing Address - Fax:860-367-0668
Practice Address - Street 1:14 GALLIVAN LN
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1208
Practice Address - Country:US
Practice Address - Phone:860-389-3148
Practice Address - Fax:860-367-0668
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048520-11223P0700X
CT0096521223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics