Provider Demographics
NPI:1083162127
Name:MARZBAN, PAMELA (DDS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MARZBAN
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 1:8996 BURKE LAKE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1607
Mailing Address - Country:US
Mailing Address - Phone:703-323-8200
Mailing Address - Fax:703-978-3679
Practice Address - Street 1:8996 BURKE LAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1607
Practice Address - Country:US
Practice Address - Phone:703-323-8200
Practice Address - Fax:703-978-3679
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist