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General NPI Number Information
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NPI Number | 1730065483
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Entity Type | Organization
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Legal Business Name | MARANATHA ROBERTSON DENTAL
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 5711 SARVIS AVE STE 502
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City | RIVERDALE
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State | MD
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Zip | 20737-1366
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Country | US
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Telephone | 301-927-1453
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Fax | 301-588-3595
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Provider Business Mailing Address
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Address Line | 5711 SARVIS AVE STE 502
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City | RIVERDALE
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State | MD
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Zip | 20737-1366
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Country | US
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Telephone | 301-927-1453
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Fax | 301-588-3595
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Authorized Official
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Title or Position | DENTIST
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Name | ALICIA H ROBERTSON
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Credential | DDS
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Telephone | 301-523-2728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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