Provider Demographics
NPI:1346245198
Name:MERLO, LEONARD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:A
Last Name:MERLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 RANDOLPH RD
Mailing Address - Street 2:STE G10
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2259
Mailing Address - Country:US
Mailing Address - Phone:301-468-0020
Mailing Address - Fax:
Practice Address - Street 1:4701 RANDOLPH RD
Practice Address - Street 2:STE G10
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2259
Practice Address - Country:US
Practice Address - Phone:301-468-0020
Practice Address - Fax:301-468-2304
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
691198Medicare ID - Type Unspecified
U56228Medicare UPIN