Provider Demographics
NPI:1730065483
Name:MARANATHA ROBERTSON DENTAL
Entity type:Organization
Organization Name:MARANATHA ROBERTSON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-523-2728
Mailing Address - Street 1:5711 SARVIS AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1366
Mailing Address - Country:US
Mailing Address - Phone:301-927-1453
Mailing Address - Fax:301-588-3595
Practice Address - Street 1:5711 SARVIS AVE STE 502
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1366
Practice Address - Country:US
Practice Address - Phone:301-927-1453
Practice Address - Fax:301-588-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental