Provider Demographics
NPI:1497361471
Name:LISA A. MARVIL, D.M.D., P.L.L.C.
Entity Type:Organization
Organization Name:LISA A. MARVIL, D.M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:MARVIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-297-6655
Mailing Address - Street 1:17341-B PICKWICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132
Mailing Address - Country:US
Mailing Address - Phone:540-338-4588
Mailing Address - Fax:540-675-4044
Practice Address - Street 1:17341-B PICKWICK DRIVE
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132
Practice Address - Country:US
Practice Address - Phone:540-338-4588
Practice Address - Fax:540-675-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty