Provider Demographics
NPI:1457672420
Name:KANLI, EROL J (DDS)
Entity Type:Individual
Prefix:
First Name:EROL
Middle Name:J
Last Name:KANLI
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 1:6116 ROLLING RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1521
Mailing Address - Country:US
Mailing Address - Phone:703-451-8332
Mailing Address - Fax:703-451-4661
Practice Address - Street 1:6116 ROLLING RD
Practice Address - Street 2:SUITE 316
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1521
Practice Address - Country:US
Practice Address - Phone:703-451-8332
Practice Address - Fax:703-451-4661
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101412835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist