Provider Demographics
NPI:1679652606
Name:BANZON, MARIE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:T
Last Name:BANZON
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 1:9000 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1514
Mailing Address - Country:US
Mailing Address - Phone:301-581-9494
Mailing Address - Fax:301-581-9587
Practice Address - Street 1:9000 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1514
Practice Address - Country:US
Practice Address - Phone:301-581-9494
Practice Address - Fax:301-581-9587
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist