Healthcare Provider Details

I. General information

NPI: 1962668293
Provider Name (Legal Business Name): WASHINGTON ORAL & FACIAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 19TH ST NW SUITE 508
WASHINGTON DC
20036-2407
US

IV. Provider business mailing address

1234 19TH ST NW SUITE 508
WASHINGTON DC
20036-2407
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-3391
  • Fax: 202-833-8874
Mailing address:
  • Phone: 202-223-3391
  • Fax: 202-833-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberDEN2822
License Number StateDC

VIII. Authorized Official

Name: DR. LEONARD A MERLO
Title or Position: OWNER
Credential: DMD, FACS
Phone: 202-223-3391