Healthcare Provider Details

I. General information

NPI: 1336708544
Provider Name (Legal Business Name): MARIA G. OBREGON MERLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 LEESBURG PIKE STE 920
VIENNA VA
22182-2714
US

IV. Provider business mailing address

8150 LEESBURG PIKE STE 920
VIENNA VA
22182-2714
US

V. Phone/Fax

Practice location:
  • Phone: 703-636-2442
  • Fax:
Mailing address:
  • Phone: 703-636-2442
  • Fax: 703-636-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416540
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: