Organization
AJ SHANNON DMD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW JASON SHANNON DMD (DENTIST)
(571) 230-8051
Entity
Organization
Contact information
Practice address
301 MAPLE AVE W, SUITE 200, VIENNA, VA 22180-4301
(703) 319-8370
(703) 319-8371
Mailing address
301 MAPLE AVE W, SUITE 200, VIENNA, VA 22180-4301
(703) 319-8370
(703) 319-8371
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401411773
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982825097
—
VA
Enumeration date
07/20/2011
Last updated
07/20/2011
Update your record
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