Active NPI
Marisa Reos, DDS
- General Practice Dentistry
- Silver Spring, MD
National Provider Identifier
1083948996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 15843
- Practice address
- 1111 University Blvd W Ste G5A
Silver Spring, MD 20902-3351 - Phone
- (301) 592-9224
- Fax
- (301) 592-9227
- NPI assigned
- Sep 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15843 | MD | Primary |
Addresses
Primary practice location
1111 University Blvd W Ste G5A
Silver Spring, MD 20902-3351
Mailing address
1111 University Blvd W Ste G5A
Silver Spring, MD 20902-3351
Phone (015) 929-2243
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15843 | MD | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Victoria S. Pedoeem, DDS | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Jersey City, NJ
- NPI 1023188455
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1083948996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 UNIVERSITY BLVD W STE G5A",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209023351",
"telephone_number": "015-929-2243",
"fax_number": "301-592-9227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 UNIVERSITY BLVD W STE G5A",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209023351",
"telephone_number": "301-592-9224",
"fax_number": "301-592-9227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REOS",
"first_name": "MARISA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-24",
"last_updated": "2021-09-09",
"certification_date": "2021-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "15843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.