MEDICARE: TOKO SIPELII B.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2092-A	AS

General Provider Information

NPI Number	:	1033500376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOKO SIPELII B.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 7014
Second Line	:	7014 OTTOVILLE ROAD, TAFUNA VILLAGE
City	:	PAGO PAGO
State	:	AS
Zip	:	96799-6293
Country	:	US
Telephone Number	:	684-733-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	7014 OTTOVILLE ROAD
Second Line	:	ISLAND SMILES, TAFUNA VILLAGE
City	:	PAGO PAGO
State	:	AS
Zip	:	96799-6293
Country	:	US
Telephone Number	:	684-733-0073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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