Provider Demographics
NPI:1093012205
Name:MARANATHA WEIR GROUP
Entity Type:Organization
Organization Name:MARANATHA WEIR GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:TM
Authorized Official - Last Name:WEIR-GLADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-927-1453
Mailing Address - Street 1:5711 SARVIS AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1366
Mailing Address - Country:US
Mailing Address - Phone:301-927-1453
Mailing Address - Fax:
Practice Address - Street 1:5711 SARVIS AVE STE 502
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1366
Practice Address - Country:US
Practice Address - Phone:301-927-1453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty