Healthcare Provider Details

I. General information

NPI: 1497687628
Provider Name (Legal Business Name): SHAILY JAIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 LINWAY TER
MC LEAN VA
22101-4143
US

IV. Provider business mailing address

6240 LINWAY TER
MC LEAN VA
22101-4143
US

V. Phone/Fax

Practice location:
  • Phone: 703-408-4138
  • Fax:
Mailing address:
  • Phone: 703-408-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: