Provider Demographics
NPI:1689007825
Name:PILGRIM, JUSTICE GERALD SHERIDAN (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:GERALD SHERIDAN
Last Name:PILGRIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 MACHINE STREET, BLDG 2501
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005
Mailing Address - Country:US
Mailing Address - Phone:406-561-0626
Mailing Address - Fax:
Practice Address - Street 1:6455 MACHINE STREET, BLDG 2501
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005
Practice Address - Country:US
Practice Address - Phone:406-561-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-6024122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist