Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2060-A | AS |
NPI | 1235528837 |
---|---|
Provider Name | Inoke Tutanekai Siasau |
First Address | Pago Pago, AS 96799 |
Second Address | Pago Pago, AS 96799-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 20/01/2015 |