Provider Demographics
NPI:1043601966
Name:MARC G. GEBALLA, D.D.S.
Entity Type:Organization
Organization Name:MARC G. GEBALLA, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GEBALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-262-1400
Mailing Address - Street 1:6911 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1712
Mailing Address - Country:US
Mailing Address - Phone:301-262-1400
Mailing Address - Fax:301-262-0827
Practice Address - Street 1:6911 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 313
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1712
Practice Address - Country:US
Practice Address - Phone:301-262-1400
Practice Address - Fax:301-262-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty