Provider Demographics
NPI:1215100524
Name:KRISTEN DONOHUE DMD PC
Entity type:Organization
Organization Name:KRISTEN DONOHUE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-978-1446
Mailing Address - Street 1:6035 BURKE CENTRE PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-978-1446
Mailing Address - Fax:703-978-2932
Practice Address - Street 1:6035 BURKE CENTRE PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3750
Practice Address - Country:US
Practice Address - Phone:703-978-1446
Practice Address - Fax:703-978-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014113971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty