Provider Demographics
NPI:1831564392
Name:JEFFREY I. KLIOZE, D.D.S., LTD
Entity type:Organization
Organization Name:JEFFREY I. KLIOZE, D.D.S., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIOZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-323-8820
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:703-323-8820
Mailing Address - Fax:703-323-8821
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:703-323-8820
Practice Address - Fax:703-323-8821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010076941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty