Provider Demographics
NPI:1740520337
Name:LAN, CINDY L
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:LAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LAN
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:374TH DENTAL SQUADRON YOKOTA AB
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96328
Mailing Address - Country:US
Mailing Address - Phone:315-225-8042
Mailing Address - Fax:
Practice Address - Street 1:374TH DENTAL SQUADRON YOKOTA AB
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328
Practice Address - Country:US
Practice Address - Phone:315-225-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice