Provider Demographics
NPI:1841483021
Name:DONOHUE, KRISTEN ALYCE (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ALYCE
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 MOREY LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1945
Mailing Address - Country:US
Mailing Address - Phone:703-763-4491
Mailing Address - Fax:
Practice Address - Street 1:8808 PEAR TREE VILLAGE CT # F
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4221
Practice Address - Country:US
Practice Address - Phone:703-780-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014113971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice