Active NPI
Marc George Geballa, DDS
- Endodontics
- Bowie, MD
National Provider Identifier
1710035878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 9990
- Practice address
- 6911 Laurel Bowie Rd Ste 313
Bowie, MD 20715-1712 - Phone
- (301) 262-1400
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 9990 | MD | Primary |
Addresses
Primary practice location
6911 Laurel Bowie Rd Ste 313
Bowie, MD 20715-1712
Mailing address
6911 Laurel Bowie Rd Ste 313
Bowie, MD 20715-1712
Phone (301) 262-1400
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 |
|---|---|---|---|
| 9990 | MD | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710035878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6911 LAUREL BOWIE RD STE 313",
"city": "BOWIE",
"state": "MD",
"postal_code": "207151712",
"telephone_number": "301-262-1400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6911 LAUREL BOWIE RD STE 313",
"city": "BOWIE",
"state": "MD",
"postal_code": "207151712",
"telephone_number": "301-262-1400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEBALLA",
"first_name": "MARC",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MD",
"license": "9990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.