Provider Demographics
NPI:1407913692
Name:PAMELA MARZBAN DDS PC
Entity Type:Organization
Organization Name:PAMELA MARZBAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:703-323-8200
Mailing Address - Street 1:8996 BURKE LAKE RD STE 101
Mailing Address - Street 2:
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 STE 101
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty