Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2070 - A | AS |
NPI | 1124426333 |
---|---|
Provider Name | Dr. Talifa J Talifa JR. |
First Address | Pago Pago, AS 96799-5666 |
Second Address | Pago Pago, AS 96799-3965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |