Provider Demographics
NPI:1811626641
Name:AGUILAR JUSTINIANO, JOCELYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYNE
Middle Name:
Last Name:AGUILAR JUSTINIANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42250 MARBLE CANYON TER
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7567
Mailing Address - Country:US
Mailing Address - Phone:703-403-4490
Mailing Address - Fax:
Practice Address - Street 1:14679 APPLE HARVEST DR STE 100
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3703
Practice Address - Country:US
Practice Address - Phone:304-707-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418006122300000X
WV4591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist