Provider Demographics
NPI:1275920175
Name:POLIZOIS, KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:POLIZOIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 14TH ST NW
Mailing Address - Street 2:APT 506
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:WASHINGTON DC VAMC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:202-745-8402
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist