Provider Demographics
NPI:1871079376
Name:WILLIAMS, LAQUINTA SHARELLE ELIM (DMD)
Entity type:Individual
Prefix:
First Name:LAQUINTA
Middle Name:SHARELLE ELIM
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LAQUINTA
Other - Middle Name:SHARELLE ELIM
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4045 JIMMIE DYESS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9492
Mailing Address - Country:US
Mailing Address - Phone:706-868-4200
Mailing Address - Fax:706-868-4717
Practice Address - Street 1:3014 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2822
Practice Address - Country:US
Practice Address - Phone:888-757-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0157231223P0221X
SCDGD112751223P0221X
SCDGD112271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDGD11275OtherSPECIALIST
SCDGD11227OtherSC
GADN015723OtherGA DENTAL BOARD