Provider Demographics
NPI:1326759853
Name:KINGSTOWNE DENTAL SPECIALISTS ORTHO LLC
Entity Type:Organization
Organization Name:KINGSTOWNE DENTAL SPECIALISTS ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MDS
Authorized Official - Phone:703-408-2868
Mailing Address - Street 1:5911 KINGSTOWNE VILLAGE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4644
Mailing Address - Country:US
Mailing Address - Phone:703-493-0622
Mailing Address - Fax:
Practice Address - Street 1:5911 KINGSTOWNE VILLAGE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-4644
Practice Address - Country:US
Practice Address - Phone:703-493-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty