Provider Demographics
NPI:1033130950
Name:ARCILLA, MARIELOU C (DDS)
Entity Type:Individual
Prefix:
First Name:MARIELOU
Middle Name:C
Last Name:ARCILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 16TH ST
Mailing Address - Street 2:STE. 123
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3240
Mailing Address - Country:US
Mailing Address - Phone:301-565-0033
Mailing Address - Fax:301-565-2746
Practice Address - Street 1:8201 16TH ST
Practice Address - Street 2:STE. 123
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3240
Practice Address - Country:US
Practice Address - Phone:301-565-0033
Practice Address - Fax:301-565-2746
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice