Provider Demographics
NPI:1689298606
Name:MILO, JUSTIN GERVAIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GERVAIS
Last Name:MILO
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 1:15200 SHADY GROVE RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6204
Mailing Address - Country:US
Mailing Address - Phone:301-330-3222
Mailing Address - Fax:
Practice Address - Street 1:15200 SHADY GROVE RD STE 450
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6204
Practice Address - Country:US
Practice Address - Phone:301-330-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDEXEMPT1122300000X
MD171441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist