Provider Demographics
NPI:1285651257
Name:MARVIL, LISA A (DMD, MHS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:MARVIL
Suffix:
Gender:F
Credentials:DMD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17341 PICKWICK DR STE B
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6178
Mailing Address - Country:US
Mailing Address - Phone:703-297-6655
Mailing Address - Fax:
Practice Address - Street 1:17341 PICKWICK DR.
Practice Address - Street 2:SUITE B
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132
Practice Address - Country:US
Practice Address - Phone:540-872-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics