Provider Demographics
NPI:1851827497
Name:MARVALOUS SMILES
Entity Type:Organization
Organization Name:MARVALOUS SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-838-0415
Mailing Address - Street 1:1818 NEW YORK AVE NE
Mailing Address - Street 2:SUITE #116
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1848
Mailing Address - Country:US
Mailing Address - Phone:202-450-2344
Mailing Address - Fax:202-450-2400
Practice Address - Street 1:1818 NEW YORK AVE NE
Practice Address - Street 2:SUITE #116
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1848
Practice Address - Country:US
Practice Address - Phone:202-450-2344
Practice Address - Fax:202-450-2400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERRING HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC5001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC060363900Medicaid
DC1568776664OtherNATIONAL PRACTITIONER IDENTIFIER (NPI)
DC122300000XOtherTAXONOMY CODE