Healthcare Provider Details

I. General information

NPI: 1922931054
Provider Name (Legal Business Name): MARINA SAMOUEL HERMEENA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MUIR ST
CAMBRIDGE MD
21613-1871
US

IV. Provider business mailing address

1851 TRUDEAU DR
FOREST HILL MD
21050-3263
US

V. Phone/Fax

Practice location:
  • Phone: 585-755-1776
  • Fax:
Mailing address:
  • Phone: 585-755-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18722
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: