MEDICARE: TUPOU TAKAYAWA BDS

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	122300000X	Dentist	6001C	AS

General Provider Information

NPI Number	:	1396693016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUPOU TAKAYAWA BDS

Provider Business Mailing Address
First Line	:	1 DR. PAUL TURNER DRIVE
Second Line	:	1 DR. PAUL TURNER DRIVE
City	:	PAGO PAGO
State	:	AS
Zip	:	96799
Country	:	US
Telephone Number	:	684-633-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 DR. PAUL TURNER DRIVE
Second Line	:	1 DR. PAUL TURNER DRIVE
City	:	PAGO PAGO
State	:	AS
Zip	:	96799
Country	:	US
Telephone Number	:	684-633-1222
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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