Provider Demographics
NPI:1720279961
Name:DR. MARK LUPOSELLO AND DR. ROBERT MARZBAN
Entity type:Organization
Organization Name:DR. MARK LUPOSELLO AND DR. ROBERT MARZBAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-356-8781
Mailing Address - Street 1:6858 OLD DOMINION DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3899
Mailing Address - Country:US
Mailing Address - Phone:703-356-8787
Mailing Address - Fax:703-442-4868
Practice Address - Street 1:6858 OLD DOMINION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3899
Practice Address - Country:US
Practice Address - Phone:703-356-8787
Practice Address - Fax:703-442-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty