Provider Demographics
NPI:1033500376
Name:SIPELII, TOKO (BDS)
Entity Type:Individual
Prefix:
First Name:TOKO
Middle Name:
Last Name:SIPELII
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7014
Mailing Address - Street 2:7014 OTTOVILLE ROAD, TAFUNA VILLAGE
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-6293
Mailing Address - Country:US
Mailing Address - Phone:684-733-0073
Mailing Address - Fax:
Practice Address - Street 1:7014 OTTOVILLE ROAD
Practice Address - Street 2:ISLAND SMILES, TAFUNA VILLAGE
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-6293
Practice Address - Country:US
Practice Address - Phone:684-733-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2092-A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice