Provider Demographics
NPI:1538179908
Name:MARCUS, CARLENE DAWN (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:DAWN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MICHAEL FARADAY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5354
Mailing Address - Country:US
Mailing Address - Phone:703-435-3030
Mailing Address - Fax:
Practice Address - Street 1:1800 MICHAEL FARADAY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5354
Practice Address - Country:US
Practice Address - Phone:703-435-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice