Provider Demographics
NPI:1396975231
Name:VANSTRALEN, KENNETH MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:VANSTRALEN
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 1:3111 TELEGRAPH CORNER LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2359
Mailing Address - Country:US
Mailing Address - Phone:703-317-3900
Mailing Address - Fax:703-317-3200
Practice Address - Street 1:3111 TELEGRAPH CORNER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2359
Practice Address - Country:US
Practice Address - Phone:703-317-3900
Practice Address - Fax:703-317-3352
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist