Provider Demographics
NPI:1700578739
Name:SRIKONGYOS, NATTASHA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:NATTASHA
Middle Name:
Last Name:SRIKONGYOS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 WOODMORE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4119
Mailing Address - Country:US
Mailing Address - Phone:301-218-4110
Mailing Address - Fax:
Practice Address - Street 1:11721 WOODMORE RD STE 170
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-4119
Practice Address - Country:US
Practice Address - Phone:301-218-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1570783122300000X
MD18339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist