Provider Demographics
NPI:1275037384
Name:S. J. LAN DDS PLLC
Entity Type:Organization
Organization Name:S. J. LAN DDS PLLC
Other - Org Name:LOUDOUN PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-899-6500
Mailing Address - Street 1:22425 BELLE TERRA DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7160
Mailing Address - Country:US
Mailing Address - Phone:240-899-6500
Mailing Address - Fax:
Practice Address - Street 1:43490 YUKON DR STE 105
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7303
Practice Address - Country:US
Practice Address - Phone:703-771-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X
VA0401412388261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA035518600Medicaid