Provider Demographics
NPI:1457989105
Name:NARLIS, JOHANNA (DDS)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:NARLIS
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 1:913 RIDGEBROOK RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9467
Mailing Address - Country:US
Mailing Address - Phone:410-472-9650
Mailing Address - Fax:
Practice Address - Street 1:913 RIDGEBROOK RD STE 206
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9467
Practice Address - Country:US
Practice Address - Phone:410-472-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist