Provider Demographics
NPI:1497093652
Name:REQUIAO, LIGIA S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LIGIA
Middle Name:S
Last Name:REQUIAO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 CONNECTICUT AVENUE, N.W.,
Mailing Address - Street 2:SUITE #109
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008
Mailing Address - Country:US
Mailing Address - Phone:202-966-1272
Mailing Address - Fax:202-364-2993
Practice Address - Street 1:4607 CONNECTICUT AVENUE, N.W.,
Practice Address - Street 2:SUITE #109
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:202-966-1272
Practice Address - Fax:202-364-2993
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEM5312122300000X
DCDEN53121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics