MEDICARE: ENRIQUE I FARINA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15013	MD

General Provider Information

NPI Number	:	1720363781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE I FARINA DMD

Provider Business Mailing Address
First Line	:	9548 MELROSE SQUARE WAY
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20882-2718
Country	:	US
Telephone Number	:	301-801-9478
Fax Number	:

Provider Business Practice Location Address
First Line	:	9548 MELROSE SQUARE WAY,
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20882-4425
Country	:	US
Telephone Number	:	301-801-9478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	01/04/2017

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