Healthcare Provider Details

I. General information

NPI: 1639317480
Provider Name (Legal Business Name): SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUARTERMASTER RD CHALAN LAULAU
SAIPAN MP
96950
US

IV. Provider business mailing address

P.O. BOX 500169
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-6323
  • Fax: 670-234-0521
Mailing address:
  • Phone: 670-234-6323
  • Fax: 670-234-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH DAVID PIERSON
Title or Position: DIRECTOR
Credential: D.D.S.
Phone: 670-234-6323