Provider Demographics
NPI:1770369399
Name:NAIVIQA, IFEREIMI B (BDS)
Entity type:Individual
Prefix:DR
First Name:IFEREIMI
Middle Name:B
Last Name:NAIVIQA
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 998214
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-6312
Mailing Address - Country:US
Mailing Address - Phone:684-254-0711
Mailing Address - Fax:
Practice Address - Street 1:TAFUNA CHC, PETESA ROAD ,TAFUNA
Practice Address - Street 2:
Practice Address - City:PAGOPAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS4114C122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist