=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770706996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IKARS V. LANS DDS AND ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44110 ASHBURN SHOPPING PLZ SUITE 166
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-729-1400
-----------------------------------------------------
Fax | 703-729-1739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44110 ASHBURN SHOPPING PLZ SUITE 166
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-729-1400
-----------------------------------------------------
Fax | 703-729-1739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. IKARS V. LANS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 703-729-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401005196
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------