Healthcare Provider Details

I. General information

NPI: 1275037384
Provider Name (Legal Business Name): S. J. LAN DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43490 YUKON DR STE 105
ASHBURN VA
20147-7303
US

IV. Provider business mailing address

22425 BELLE TERRA DR
ASHBURN VA
20148-7160
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-0007
  • Fax:
Mailing address:
  • Phone: 240-899-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401412388
License Number StateVA

VIII. Authorized Official

Name: DR. STEVE J LAN
Title or Position: OWNER
Credential: DDS
Phone: 240-899-6500