Provider Demographics
NPI:1689728503
Name:KAN, MARYANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6389 LITTLE RIVER TPKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5002
Mailing Address - Country:US
Mailing Address - Phone:703-916-0955
Mailing Address - Fax:703-916-0680
Practice Address - Street 1:6389 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5002
Practice Address - Country:US
Practice Address - Phone:703-916-0955
Practice Address - Fax:703-916-0680
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist