| Montgomery Oral & Facial Surgery, Llc | |
|
4701 Randolph Rd G10 Rockville MD 20852-2257 | |
| (301) 468-0020 | |
| Not Available |
| Full Name | Montgomery Oral & Facial Surgery, Llc |
|---|---|
| Speciality | Dentist |
| Location | 4701 Randolph Rd, Rockville, Maryland |
| Authorized Official Name and Position | Leonard Merlo (OWNER) |
| Authorized Official Contact | 3014680020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montgomery Oral & Facial Surgery, Llc 4701 Randolph Rd G10 Rockville MD 20852-2257 Ph: () - | Montgomery Oral & Facial Surgery, Llc 4701 Randolph Rd G10 Rockville MD 20852-2257 Ph: (301) 468-0020 |
| NPI Number | 1942573860 |
|---|---|
| Provider Enumeration Date | 02/23/2012 |
| Last Update Date | 02/23/2012 |
| Medicare PECOS PAC ID | 1355500794 |
|---|---|
| Medicare Enrollment ID | O20120305000537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942573860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 11822 (Maryland) | Primary |
| Provider Name | Leonard A Merlo |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1346245198 PECOS PAC ID: 7012969280 Enrollment ID: I20050216000068 |
| Provider Name | Farzaneh Rostami |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1295055762 PECOS PAC ID: 3173847175 Enrollment ID: I20150122001658 |
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