Provider Demographics
NPI:1639317480
Name:SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Entity Type:Organization
Organization Name:SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:670-234-6323
Mailing Address - Street 1:P.O. BOX 500169
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-234-6323
Mailing Address - Fax:670-234-0521
Practice Address - Street 1:1 QUARTERMASTER RD
Practice Address - Street 2:CHALAN LAULAU
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-6323
Practice Address - Fax:670-234-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty