Provider Demographics
NPI:1639223787
Name:PANGILINAN, KATHERINE MARTIN (RDH)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MARTIN
Last Name:PANGILINAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 CRACKLING CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-5206
Mailing Address - Country:US
Mailing Address - Phone:703-753-9558
Mailing Address - Fax:
Practice Address - Street 1:313 PARK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3327
Practice Address - Country:US
Practice Address - Phone:703-237-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203760124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist