Healthcare Provider Details

I. General information

NPI: 1356135313
Provider Name (Legal Business Name): ORLYNE MEGOUANG FAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MUIR ST
CAMBRIDGE MD
21613-1871
US

IV. Provider business mailing address

21220 SENECA CROSSING DR
GERMANTOWN MD
20876-4312
US

V. Phone/Fax

Practice location:
  • Phone: 240-595-8671
  • Fax:
Mailing address:
  • Phone: 240-595-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18614
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: