Provider Demographics
NPI:1689702672
Name:MAHN, DOUGLAS HARRY (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HARRY
Last Name:MAHN
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 1:10610B CRESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109
Mailing Address - Country:US
Mailing Address - Phone:703-392-8844
Mailing Address - Fax:703-365-0123
Practice Address - Street 1:10610B CRESTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-392-8844
Practice Address - Fax:703-365-0123
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics