| Loudoun Pediatric Dentistry | |
|
43490 Yukon Dr Ste 105 Ashburn VA 20147-7303 | |
| (703) 771-0007 | |
| Not Available |
| Full Name | Loudoun Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 43490 Yukon Dr Ste 105, Ashburn, Virginia |
| Authorized Official Name and Position | Steve J Lan (OWNER) |
| Authorized Official Contact | 2408996500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Loudoun Pediatric Dentistry 22425 Belle Terra Dr Ashburn VA 20148-7160 Ph: (240) 899-6500 | Loudoun Pediatric Dentistry 43490 Yukon Dr Ste 105 Ashburn VA 20147-7303 Ph: (703) 771-0007 |
| NPI Number | 1275037384 |
|---|---|
| Provider Enumeration Date | 03/22/2018 |
| Last Update Date | 07/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275037384 | NPI | - | NPPES |
| 035518600 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | 0401412388 (Virginia) | Secondary |
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