Individual provider Active NPI

Jeffrey Ira Klioze, DDS

  • General Practice Dentistry
  • Fairfax Station, VA
National Provider Identifier
1184791758
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401007694 Issued in VA
Practice address
9607 Pemberly LN
Fairfax Station, VA 22039-3234
Phone
(703) 493-8488
NPI assigned
Nov 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401007694 VA Primary

Addresses

Primary practice location

9607 Pemberly LN
Fairfax Station, VA 22039-3234

Mailing address

9607 Pemberly LN
Fairfax Station, VA 22039-3234
Phone (703) 493-8488

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231206004069 DC Order and Referring Only - DentistPractitioner - Dentist 7719286079

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184791758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9607 PEMBERLY LN",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220393234",
            "telephone_number": "703-493-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9607 PEMBERLY LN",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220393234",
            "telephone_number": "703-493-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIOZE",
        "first_name": "JEFFREY",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401007694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax Station, VA

Sources for this page

Verify at the official NPI Registry.