Basic Information
| Provider Information | |||||||||
| NPI: | 1548555758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAWAKALI | ||||||||
| FirstName: | LAJOYOUS | ||||||||
| MiddleName: | SALIEA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5455 16TH AVE | ||||||||
| Address2: | UNIT T4 | ||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207823427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405281511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1900 MASSACHUSETTS AVE SE | ||||||||
| Address2: | BUILDING 29 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200032542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025486500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 02/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN1001214 | DC | Y | Dental Providers | Dentist |
No ID Information.