Provider Demographics
NPI:1124426333
Name:TALIFA, TALIFA J JR (BDS)
Entity type:Individual
Prefix:DR
First Name:TALIFA
Middle Name:J
Last Name:TALIFA
Suffix:JR
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 5666
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-5666
Mailing Address - Country:US
Mailing Address - Phone:168-469-9638
Mailing Address - Fax:168-469-9637
Practice Address - Street 1:3965 TAFUNA PETESA ROAD
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-3965
Practice Address - Country:US
Practice Address - Phone:684-699-6380
Practice Address - Fax:684-699-6374
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2070 - A1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health