Healthcare Provider Details

I. General information

NPI: 1619756269
Provider Name (Legal Business Name): LUCIANA DE MELLO MARINHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20036 GOSHEN RD
GAITHERSBURG MD
20879-1604
US

IV. Provider business mailing address

3637 MARCEY CREEK RD
LAUREL MD
20724-1912
US

V. Phone/Fax

Practice location:
  • Phone: 240-683-6009
  • Fax:
Mailing address:
  • Phone: 240-708-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8429
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: