Provider Demographics
NPI:1982879219
Name:TAPPAN, MARCUS STEPHEN
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:STEPHEN
Last Name:TAPPAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 2ND AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3372
Mailing Address - Country:US
Mailing Address - Phone:301-565-8212
Mailing Address - Fax:301-565-9458
Practice Address - Street 1:8611 2ND AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3372
Practice Address - Country:US
Practice Address - Phone:301-565-8212
Practice Address - Fax:301-565-9458
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist