Marissa N. Bender, DMD, MBA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00009155 Issued in WA

Practice address

5017 196TH St SW
Ste 202
Lynnwood, WA 98036-6123

Phone

(425) 778-5665

Fax

(425) 778-3356

NPI assigned

May 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

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.

• Suman Chintala Family Dental PLLC

  dba Lynnwood dental studio

  • Dental Clinic/Center
  • Lynnwood, WA
  • NPI 1740706373
  NPD (past)

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186963200000",
    "number": "1215988050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4024 116TH ST SE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982085371",
            "telephone_number": "425-316-9268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5017 196TH ST SW",
            "address_2": "STE 202",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366123",
            "telephone_number": "425-778-5665",
            "fax_number": "425-778-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENDER",
        "first_name": "MARISSA",
        "middle_name": "N.",
        "name_prefix": "Mrs.",
        "credential": "DMD, MBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2007-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER",
            "identifier": "01606946",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHA/FORTIS PROVIDER ID",
            "identifier": "51909",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "5582BE",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DENTAL SERVICE",
            "identifier": "28641",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHA PRACTICE ID",
            "identifier": "48726",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5046057",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lachlin J Bell Duffy
• Alina Viola Bell-Games, BSN, RN, CNN
• James E. Bell I, MD
• Jane Bellousov
• Shannon Michelle Bemis, PHARMD
• Hillary Ann Bendiksen, LMHC
• Vadym Bendzar
• Brenda Elaine Benjamin, RN
• Leif Benjestorf, ARNP
• Archer Bennett

• General Practice Dentistry in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.