Provider Demographics
NPI:1962668293
Name:WASHINGTON ORAL & FACIAL SURGERY, PC
Entity type:Organization
Organization Name:WASHINGTON ORAL & FACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FACS
Authorized Official - Phone:202-223-3391
Mailing Address - Street 1:1234 19TH ST NW
Mailing Address - Street 2:SUITE 508
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2407
Mailing Address - Country:US
Mailing Address - Phone:202-223-3391
Mailing Address - Fax:202-833-8874
Practice Address - Street 1:1234 19TH ST NW
Practice Address - Street 2:SUITE 508
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2407
Practice Address - Country:US
Practice Address - Phone:202-223-3391
Practice Address - Fax:202-833-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN2822261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCT30932Medicare UPIN
DC145927Medicare PIN