=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356581300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H & M COSMETIC DENTISTRY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2009
-----------------------------------------------------
Last Update Date | 06/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MARYLAND AVE STE A
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-355-5155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 MARYLAND AVE STE A
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-355-5155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HERBERT MOLLINEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-355-5155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 14134
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------