Marc G. Geballa, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

9990 Issued in MD

Legal business name

MARC G. GEBALLA, D.D.S.

Practice address

6911 Laurel Bowie Rd
Suite 313
Bowie, MD 20715-1712

Phone

(301) 262-1400

Fax

(301) 262-0827

NPI assigned

Feb 13, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marc George Geballa, DDS

Title

Dentist

Phone

(301) 262-1400

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423785600000",
    "number": "1043601966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD",
            "address_2": "SUITE 313",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207151712",
            "telephone_number": "301-262-1400",
            "fax_number": "301-262-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD",
            "address_2": "SUITE 313",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207151712",
            "telephone_number": "301-262-1400",
            "fax_number": "301-262-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARC G. GEBALLA, D.D.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2015-02-13",
        "status": "A",
        "authorized_official_last_name": "GEBALLA",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "301-262-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "9990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.