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General NPI Number Information
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NPI Number | 1043601966
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Entity Type | Organization
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Legal Business Name | MARC G. GEBALLA, D.D.S.
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 6911 LAUREL BOWIE RD SUITE 313
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 301-262-1400
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Fax | 301-262-0827
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Provider Business Mailing Address
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Address Line | 6911 LAUREL BOWIE RD SUITE 313
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 301-262-1400
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Fax | 301-262-0827
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARC GEORGE GEBALLA
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Credential | DDS
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Telephone | 301-262-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9990
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License Number State | MD
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