NPIMap

Organization Active NPI

Aj Shannon DMD PLC

  • Pediatric Dentistry
  • Vienna, VA
National Provider Identifier
1962790261
Registry record updated Jul 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401411773 Issued in VA
Legal business name
AJ SHANNON DMD PLC
Practice address
301 Maple Ave W
Suite 200
Vienna, VA 22180-4301
Phone
(703) 319-8370
Fax
(703) 319-8371
NPI assigned
Jul 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew Jason Shannon, DMD
Title
Dentist
Phone
(571) 230-8051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 0401411773 VA Primary

Addresses

Primary practice location

301 Maple Ave W
Suite 200
Vienna, VA 22180-4301

Mailing address

301 Maple Ave W
Suite 200
Vienna, VA 22180-4301
Phone (703) 319-8370

Other identifiers 1

IdentifierTypeStateIssuer
1982825097MedicaidVA

National Provider Directory

National Provider Directory

Locations

301 Maple Ave W
Ste 200
Vienna, VA 22180
Phone (571) 230-8915

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1962790261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MAPLE AVE W",
            "address_2": "SUITE 200",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804301",
            "telephone_number": "703-319-8370",
            "fax_number": "703-319-8371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MAPLE AVE W",
            "address_2": "SUITE 200",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804301",
            "telephone_number": "703-319-8370",
            "fax_number": "703-319-8371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AJ SHANNON DMD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "571-230-8051",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401411773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982825097",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.