Provider Demographics
NPI:1780804377
Name:DUMLAO, RUSTICO JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RUSTICO
Middle Name:
Last Name:DUMLAO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9661 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3757
Mailing Address - Country:US
Mailing Address - Phone:703-425-3737
Mailing Address - Fax:703-425-3762
Practice Address - Street 1:3320 NOBLE POND WAY STE 109
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1470
Practice Address - Country:US
Practice Address - Phone:703-640-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice