Provider Demographics
NPI:1003061300
Name:WILLIAMS, TONGELA LATARSHA
Entity Type:Individual
Prefix:DR
First Name:TONGELA
Middle Name:LATARSHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 OAKPOST CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:301-856-0079
Mailing Address - Fax:
Practice Address - Street 1:83 HIGH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:301-645-3501
Practice Address - Fax:301-705-5396
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136801223G0001X
DCDEN10005491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice