Provider Demographics
NPI:1215044011
Name:KAN, GLEN ANTHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ANTHEN
Last Name:KAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 LOCKWOOD DRIVE
Mailing Address - Street 2:STE 390
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1562
Mailing Address - Country:US
Mailing Address - Phone:301-585-7766
Mailing Address - Fax:301-585-7767
Practice Address - Street 1:10801 LOCKWOOD DRIVE
Practice Address - Street 2:STE 390
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1562
Practice Address - Country:US
Practice Address - Phone:301-585-7766
Practice Address - Fax:301-585-7767
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist