Provider Demographics
NPI:1063491785
Name:JUGAN, MILAN JOHN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILAN
Middle Name:JOHN
Last Name:JUGAN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:72780 COUNTRY CLUB DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4004
Mailing Address - Country:US
Mailing Address - Phone:760-837-1515
Mailing Address - Fax:760-837-1011
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4004
Practice Address - Country:US
Practice Address - Phone:760-837-1515
Practice Address - Fax:760-837-1011
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028293L1223S0112X
MD119161223S0112X
CA522241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery