Provider Demographics
NPI:1508101916
Name:MICHAEL L KAHAN, DDS, PC
Entity Type:Organization
Organization Name:MICHAEL L KAHAN, DDS, PC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-563-8000
Mailing Address - Street 1:2129 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5872
Mailing Address - Country:US
Mailing Address - Phone:757-563-8000
Mailing Address - Fax:757-563-2077
Practice Address - Street 1:2129 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5872
Practice Address - Country:US
Practice Address - Phone:757-563-8000
Practice Address - Fax:757-563-2077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty