MEDICARE: DR. GLEN ANTHEN KAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10392	MD

General Provider Information

NPI Number	:	1215044011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN ANTHEN KAN DDS

Provider Business Mailing Address
First Line	:	10801 LOCKWOOD DRIVE
Second Line	:	STE 390
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1562
Country	:	US
Telephone Number	:	301-585-7766
Fax Number	:	301-585-7767

Provider Business Practice Location Address
First Line	:	10801 LOCKWOOD DRIVE
Second Line	:	STE 390
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1562
Country	:	US
Telephone Number	:	301-585-7766
Fax Number	:	301-585-7767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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