Healthcare Provider Details

I. General information

NPI: 1932032786
Provider Name (Legal Business Name): MJ COSMETIC DENTISTRYLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20036 GOSHEN RD
GAITHERSBURG MD
20879-1604
US

IV. Provider business mailing address

9548 MELROSE SQUARE WAY
GAITHERSBURG MD
20882-2718
US

V. Phone/Fax

Practice location:
  • Phone: 240-683-6009
  • Fax:
Mailing address:
  • Phone: 301-801-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ENRIQUE FARINA
Title or Position: OWNER
Credential: DMD
Phone: 301-801-9478