Provider Demographics
NPI:1083948996
Name:REOS, MARISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:REOS
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 1:1111 UNIVERSITY BLVD W STE G5A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3351
Mailing Address - Country:US
Mailing Address - Phone:015-929-2243
Mailing Address - Fax:301-592-9227
Practice Address - Street 1:1111 UNIVERSITY BLVD W STE G5A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3351
Practice Address - Country:US
Practice Address - Phone:301-592-9224
Practice Address - Fax:301-592-9227
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice