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General NPI Number Information
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NPI Number | 1336708544
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Entity Type | Individual
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Provider Name | MARIA G. OBREGON MERLO DMD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 8150 LEESBURG PIKE STE 920
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City | VIENNA
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State | VA
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Zip | 22182-2714
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Country | US
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Telephone | 703-636-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 8150 LEESBURG PIKE STE 920
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City | VIENNA
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State | VA
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Zip | 22182-2714
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Country | US
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Telephone | 703-636-2442
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Fax | 703-636-2440
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401416540
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License Number State | VA
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