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General NPI Number Information
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NPI Number | 1932032786
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Entity Type | Organization
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Legal Business Name | MJ COSMETIC DENTISTRYLLC
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 20036 GOSHEN RD
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City | GAITHERSBURG
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State | MD
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Zip | 20879-1604
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Country | US
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Telephone | 240-683-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 9548 MELROSE SQUARE WAY
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City | GAITHERSBURG
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State | MD
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Zip | 20882-2718
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Country | US
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Telephone | 301-801-9478
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ENRIQUE FARINA
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Credential | DMD
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Telephone | 301-801-9478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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