Provider Demographics
NPI:1437496775
Name:LOLOEI MARSAL, VIDA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:
Last Name:LOLOEI MARSAL
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 1:2221 E BIJOU ST STE 1002221E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8008
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:3401 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2501
Practice Address - Country:US
Practice Address - Phone:202-829-5437
Practice Address - Fax:202-829-9255
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15866122300000X
DCDEN10016021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC058298500Medicaid
MD119914500Medicaid