Provider Demographics
NPI:1316079155
Name:KLOS, ZENON ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:ZENON
Middle Name:ALEXANDER
Last Name:KLOS
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 1:848 E 185TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119
Mailing Address - Country:US
Mailing Address - Phone:216-531-7700
Mailing Address - Fax:216-531-1047
Practice Address - Street 1:848 E 185TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119
Practice Address - Country:US
Practice Address - Phone:216-531-7700
Practice Address - Fax:216-531-1047
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist