Provider Demographics
NPI:1619756269
Name:DE MELLO MARINHO, LUCIANA
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:DE MELLO MARINHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 MARCEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1912
Mailing Address - Country:US
Mailing Address - Phone:240-708-9551
Mailing Address - Fax:
Practice Address - Street 1:20036 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1604
Practice Address - Country:US
Practice Address - Phone:240-683-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8429124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist