MEDICARE: DR. ROGER LOUIS MARCELLIN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5999	VA

General Provider Information

NPI Number	:	1437341641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER LOUIS MARCELLIN D.D.S.

Provider Business Mailing Address
First Line	:	11351 RANDOM HILLS RD STE 290
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6081
Country	:	US
Telephone Number	:	703-293-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11351 RANDOM HILLS RD STE 290
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6081
Country	:	US
Telephone Number	:	703-293-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2007
Last Update Date	:	08/02/2021

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Directions to “ DR. ROGER LOUIS MARCELLIN D.D.S.” Practice Location

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