Healthcare Provider Details

I. General information

NPI: 1548555758
Provider Name (Legal Business Name): LAJOYOUS SALIEA TAWAKALI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MASSACHUSETTS AVE SE BUILDING 29
WASHINGTON DC
20003-2542
US

IV. Provider business mailing address

5455 16TH AVE UNIT T4
HYATTSVILLE MD
20782-3427
US

V. Phone/Fax

Practice location:
  • Phone: 202-548-6500
  • Fax:
Mailing address:
  • Phone: 240-528-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001214
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: