Provider Demographics
NPI:1962672535
Name:AILIN SHAN,DMD,PLLC
Entity Type:Organization
Organization Name:AILIN SHAN,DMD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-756-6658
Mailing Address - Street 1:5412 GLENSIDE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3995
Mailing Address - Country:US
Mailing Address - Phone:804-756-6658
Mailing Address - Fax:804-756-6662
Practice Address - Street 1:5412 GLENSIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3995
Practice Address - Country:US
Practice Address - Phone:804-756-6658
Practice Address - Fax:804-756-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9180406Medicaid