MEDICARE: DR. SIONA MOTUFAU JR. DDS CO

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
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144078684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SIONA MOTUFAU JR. DDS CO

Provider Business Mailing Address
First Line	:	425 NORTH AVE STE A
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-7576
Country	:	US
Telephone Number	:	970-615-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 NORTH AVE STE A
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-7576
Country	:	US
Telephone Number	:	970-615-7500
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SIONA MOTUFAU JR.
Credential	:	DDS
Telephone Number	:	970-712-1463

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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