| |
4000 South Old State Rd Us 37 Bloomington IN 47401-7412 | |
(812) 824-1600 | |
(812) 824-1615 |
Full Name | |
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Speciality | Dentist |
Location | 4000 South Old State Rd Us 37, Bloomington, Indiana |
Authorized Official Name and Position | Ryan Edward Kloboves (DENTIST) |
Authorized Official Contact | 8128241600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4000 S. Old State Rd Us 37 Bloomington IN 47401-7412 Ph: (812) 824-1600 | 4000 South Old State Rd Us 37 Bloomington IN 47401-7412 Ph: (812) 824-1600 |
NPI Number | 1851628903 |
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Provider Enumeration Date | 11/11/2009 |
Last Update Date | 11/11/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851628903 | NPI | - | NPPES |
200522010 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 12010746B (Indiana) | Primary |
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