Healthcare Provider Details

I. General information

NPI: 1083795033
Provider Name (Legal Business Name): MARVALEE M MATTRASINGH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 POWDER MILL ROAD
ADELPHI MD
20783
US

IV. Provider business mailing address

3222 POWDER MILL ROAD
ADELPHI MD
20783
US

V. Phone/Fax

Practice location:
  • Phone: 301-937-8872
  • Fax: 301-937-5593
Mailing address:
  • Phone: 301-937-8872
  • Fax: 301-937-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: