Healthcare Provider Details

I. General information

NPI: 1063491785
Provider Name (Legal Business Name): MILAN JOHN JUGAN JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 SABRE ST STE 260
VIRGINIA BEACH VA
23452-7365
US

IV. Provider business mailing address

2875 SABRE ST STE 260
VIRGINIA BEACH VA
23452-7365
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-6886
  • Fax: 757-499-3464
Mailing address:
  • Phone: 757-499-6886
  • Fax: 757-499-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401417702
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS028293L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11916
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number52224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: