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General NPI Number Information
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NPI Number | 1497093652
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Entity Type | Individual
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Provider Name | LIGIA S. REQUIAO D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 4607 CONNECTICUT AVENUE, N.W., SUITE #109
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City | WASHINGTON
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State | DC
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Zip | 20008
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Country | US
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Telephone | 202-966-1272
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Fax | 202-364-2993
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Provider Business Mailing Address
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Address Line | 4607 CONNECTICUT AVENUE, N.W., SUITE #109
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City | WASHINGTON
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State | DC
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Zip | 20008
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Country | US
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Telephone | 202-966-1272
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Fax | 202-364-2993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEM5312
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DEN5312
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License Number State | DC
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