| Aj Shannon Dmd Plc | |
|
301 Maple Ave W Suite 200 Vienna VA 22180-4301 | |
| (703) 319-8370 | |
| (703) 319-8371 |
| Full Name | Aj Shannon Dmd Plc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 301 Maple Ave W, Vienna, Virginia |
| Authorized Official Name and Position | Andrew Jason Shannon (DENTIST) |
| Authorized Official Contact | 5712308051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aj Shannon Dmd Plc 301 Maple Ave W Suite 200 Vienna VA 22180-4301 Ph: (703) 319-8370 | Aj Shannon Dmd Plc 301 Maple Ave W Suite 200 Vienna VA 22180-4301 Ph: (703) 319-8370 |
| NPI Number | 1962790261 |
|---|---|
| Provider Enumeration Date | 07/20/2011 |
| Last Update Date | 07/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962790261 | NPI | - | NPPES |
| 1982825097 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 0401411773 (Virginia) | Primary |
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