Provider Demographics
NPI:1114028933
Name:KLIMA, RODNEY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JOHN
Last Name:KLIMA
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 1:5204 LYNGATE CT # B
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1631
Mailing Address - Country:US
Mailing Address - Phone:703-425-5125
Mailing Address - Fax:703-425-6281
Practice Address - Street 1:5204 LYNGATE CT # B
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1631
Practice Address - Country:US
Practice Address - Phone:703-425-5125
Practice Address - Fax:703-425-6281
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178575Medicaid