MEDICARE: LILIA G. BANZON, MD, PC T/A MARIE T. BANZON, DDS

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	122300000X	Dentist	10905	MD

General Provider Information

NPI Number	:	1538248554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILIA G. BANZON, MD, PC T/A MARIE T. BANZON, DDS

Provider Business Mailing Address
First Line	:	9000 OLD GEORGETOWN RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-1514
Country	:	US
Telephone Number	:	301-581-9494
Fax Number	:	301-581-9587

Provider Business Practice Location Address
First Line	:	9000 OLD GEORGETOWN RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-1514
Country	:	US
Telephone Number	:	301-581-9494
Fax Number	:	301-581-9587

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIE T. BANZON
Credential	:	DDS
Telephone Number	:	301-581-9494

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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