Provider Demographics
NPI:1629838537
Name:TAFUNA'I, JOSEPH ROY
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROY
Last Name:TAFUNA'I
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:TAFUNA'I
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2051 N TORREY PINES DR APT 1040
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 W CHARLESTON BLVD BLDG D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2335
Practice Address - Country:US
Practice Address - Phone:801-920-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV8052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program