MEDICARE: DR. JUSTIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401416976	VA

General Provider Information

NPI Number	:	1881258408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN DO

Provider Business Mailing Address
First Line	:	12809 PILOTS LANDING WAY APT SUITE
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-6118
Country	:	US
Telephone Number	:	240-644-5394
Fax Number	:

Provider Business Practice Location Address
First Line	:	14007 MINNIEVILLE RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2310
Country	:	US
Telephone Number	:	703-670-5414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	10/19/2021

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