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General NPI Number Information
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NPI Number | 1275037384
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Entity Type | Organization
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Legal Business Name | S. J. LAN DDS PLLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 43490 YUKON DR STE 105
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City | ASHBURN
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State | VA
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Zip | 20147-7303
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Country | US
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Telephone | 703-771-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 22425 BELLE TERRA DR
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City | ASHBURN
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State | VA
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Zip | 20148-7160
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Country | US
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Telephone | 240-899-6500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVE J LAN
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Credential | DDS
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Telephone | 240-899-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401412388
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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