Provider Demographics
NPI:1053503151
Name:MARZBAN, ROBERT BABAK (DDS MDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BABAK
Last Name:MARZBAN
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 OLD DOMINION DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-356-8781
Mailing Address - Fax:703-442-4868
Practice Address - Street 1:6858 OLD DOMINION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3899
Practice Address - Country:US
Practice Address - Phone:703-356-8781
Practice Address - Fax:703-442-4868
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100321223X0400X
NY056091-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics