Provider Demographics
NPI:1053449231
Name:KLIOZE, EARL EPHRIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:EPHRIAM
Last Name:KLIOZE
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 1:9425 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1522
Mailing Address - Country:US
Mailing Address - Phone:703-323-9120
Mailing Address - Fax:
Practice Address - Street 1:9425 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1522
Practice Address - Country:US
Practice Address - Phone:703-323-9120
Practice Address - Fax:
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
VAVA 33731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice