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General NPI Number Information
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NPI Number | 1689426363
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Entity Type | Individual
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Provider Name | KITIONE BALAWA VUKUNISIGA
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Gender | Male
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | ROTA HEALTH CENTRE
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City | SAIPAN
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State | MP
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Zip | 96951
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Country | US
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Telephone | 670-532-9461
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 500409
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City | SAIPAN
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State | MP
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Zip | 96950-0409
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Country | US
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Telephone | 670-234-8950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125J00000X
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Taxonomy Name | Dental Therapist
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License Number | 024
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License Number State | MP
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