Provider Demographics
NPI:1962892810
Name:DR. SIONA MOTUFAU JR. DDS CO
Entity type:Organization
Organization Name:DR. SIONA MOTUFAU JR. DDS CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTUFAU
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-712-1463
Mailing Address - Street 1:1404 HAWK PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6470
Mailing Address - Country:US
Mailing Address - Phone:970-615-7500
Mailing Address - Fax:970-615-7502
Practice Address - Street 1:333 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4257
Practice Address - Country:US
Practice Address - Phone:970-615-7500
Practice Address - Fax:970-615-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34533214Medicaid