Provider Demographics
NPI:1356035638
Name:ADZIMA, MARSHALL DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:DAVID
Last Name:ADZIMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 BUST HEAD RD
Mailing Address - Street 2:
Mailing Address - City:BROAD RUN
Mailing Address - State:VA
Mailing Address - Zip Code:20137-1711
Mailing Address - Country:US
Mailing Address - Phone:703-853-3061
Mailing Address - Fax:
Practice Address - Street 1:361 WALKER DR STE 204
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-4364
Practice Address - Country:US
Practice Address - Phone:540-341-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014184901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice