Provider Demographics
NPI:1851962757
Name:KOCAN, JESSICA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KOCAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N RANDOLPH ST APT 1200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2188
Mailing Address - Country:US
Mailing Address - Phone:814-881-2729
Mailing Address - Fax:
Practice Address - Street 1:22855 BRAMBLETON PLZ STE 200
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-4871
Practice Address - Country:US
Practice Address - Phone:703-327-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014173201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics