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General NPI Number Information
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NPI Number | 1326759853
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Entity Type | Organization
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Legal Business Name | KINGSTOWNE DENTAL SPECIALISTS ORTHO LLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 5911 KINGSTOWNE VILLAGE PKWY STE 150
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City | ALEXANDRIA
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State | VA
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Zip | 22315-4644
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Country | US
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Telephone | 703-493-0622
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Fax |
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Provider Business Mailing Address
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Address Line | 5911 KINGSTOWNE VILLAGE PKWY STE 150
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City | ALEXANDRIA
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State | VA
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Zip | 22315-4644
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Country | US
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Telephone | 703-493-0622
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ROBERT MARZBAN
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Credential | DDS MDS
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Telephone | 703-408-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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