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General NPI Number Information
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NPI Number | 1497361471
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Entity Type | Organization
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Legal Business Name | LISA A. MARVIL, D.M.D., P.L.L.C.
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 17341-B PICKWICK DRIVE
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City | PURCELLVILLE
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State | VA
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Zip | 20132
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Country | US
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Telephone | 540-338-4588
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Fax | 540-675-4044
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Provider Business Mailing Address
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Address Line | 17341-B PICKWICK DRIVE
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City | PURCELLVILLE
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State | VA
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Zip | 20132
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Country | US
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Telephone | 540-338-4588
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Fax | 540-675-4044
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Authorized Official
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Title or Position | OWNER/PERIODONTICS
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Name | DR. LISA ALISON MARVIL
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Credential | D.M.D
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Telephone | 703-297-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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