Provider Demographics
NPI:1205855152
Name:PENG, DENNIS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
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 1:280 HENRY ST
Mailing Address - Street 2:BETANCES HEALTH CENTER
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-227-8401
Mailing Address - Fax:212-227-8842
Practice Address - Street 1:280 HENRY ST
Practice Address - Street 2:BETANCES HEALTH CENTER
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-227-8401
Practice Address - Fax:212-227-8842
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0410431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice