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General NPI Number Information
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NPI Number | 1194949214
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Entity Type | Organization
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Legal Business Name | MARLA KUSH PROKOP, DMD, PA
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 621 RIDGELY AVE SUITE 202
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1081
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Country | US
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Telephone | 410-897-1931
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Fax | 410-897-1932
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Provider Business Mailing Address
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Address Line | 621 RIDGELY AVE SUITE 202
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1081
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Country | US
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Telephone | 410-897-1931
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Fax | 410-897-1932
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. MARLA KUSH PROKOP
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Credential | DMD
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Telephone | 410-897-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12877
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License Number State | MD
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