Provider Demographics
NPI:1730252156
Name:KORRIGAN, MARY JANE CATHERINE (RDH)
Entity type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:CATHERINE
Last Name:KORRIGAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:MARY JANE
Other - Middle Name:CATHERINE
Other - Last Name:OLEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:43925 FELICITY PLACE
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-729-3988
Mailing Address - Fax:
Practice Address - Street 1:1712 CLUBHOUSE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-471-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402004555124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist