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General NPI Number Information
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NPI Number | 1073812913
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Entity Type | Organization
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Legal Business Name | FAMILY COSMETIC & IMPLANT DENTISTRY
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 3222 POWDER MILL RD
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City | ADELPHI
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State | MD
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Zip | 20783-1037
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Country | US
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Telephone | 301-937-8872
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 POWDER MILL RD
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City | ADELPHI
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State | MD
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Zip | 20783-1037
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Country | US
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Telephone | 301-937-8872
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARVALEE M MATTRASINGH
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Credential | DDS
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Telephone | 301-937-8872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | MD11549
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | MD11535
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License Number State | MD
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