Provider Demographics
NPI:1336708544
Name:OBREGON MERLO, MARIA G (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:OBREGON MERLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 LEESBURG PIKE STE 920
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2714
Mailing Address - Country:US
Mailing Address - Phone:703-636-2442
Mailing Address - Fax:703-636-2440
Practice Address - Street 1:8150 LEESBURG PIKE STE 920
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2714
Practice Address - Country:US
Practice Address - Phone:703-636-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice