MEDICARE: DR. MARISA REOS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15843	MD

General Provider Information

NPI Number	:	1083948996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISA REOS DDS

Provider Business Mailing Address
First Line	:	1111 UNIVERSITY BLVD W STE G5A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-3351
Country	:	US
Telephone Number	:	15-929-2243
Fax Number	:	301-592-9227

Provider Business Practice Location Address
First Line	:	1111 UNIVERSITY BLVD W STE G5A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-3351
Country	:	US
Telephone Number	:	301-592-9224
Fax Number	:	301-592-9227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/09/2021

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