Provider Demographics
NPI:1386724409
Name:ISLAND, MARIA GEMA (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GEMA
Last Name:ISLAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GEMA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1500 CORNERSIDE BLVD
Mailing Address - Street 2:310
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2433
Mailing Address - Country:US
Mailing Address - Phone:703-970-1320
Mailing Address - Fax:703-790-0455
Practice Address - Street 1:1500 CORNERSIDE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2433
Practice Address - Country:US
Practice Address - Phone:703-790-1329
Practice Address - Fax:703-790-0455
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04450000111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry