Provider Demographics
NPI:1639664170
Name:SILL, MEGAN ASHLEY KEYNTON (DMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ASHLEY KEYNTON
Last Name:SILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21351 RIDGETOP CIR STE 130
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6561
Mailing Address - Country:US
Mailing Address - Phone:703-444-3710
Mailing Address - Fax:
Practice Address - Street 1:21351 RIDGETOP CIR STE 130
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6561
Practice Address - Country:US
Practice Address - Phone:703-444-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401416444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program