Provider Demographics
NPI:1689663346
Name:NKUNGULA-HOWLETT, TANIA CHIMWEMWE (DDS)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:CHIMWEMWE
Last Name:NKUNGULA-HOWLETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:NKUNGULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1401 MERCANTILE LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4301
Mailing Address - Country:US
Mailing Address - Phone:301-341-0041
Mailing Address - Fax:301-341-0014
Practice Address - Street 1:1401 MERCANTILE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4301
Practice Address - Country:US
Practice Address - Phone:301-341-0041
Practice Address - Fax:301-341-0014
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10009081223S0112X
VA04380002761223S0112X
MD144261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNVO3431Medicare UPIN