| Klockow Pc | |
|
118 S Van Rensselaer St Rensselaer IN 47978-2815 | |
| (219) 869-1097 | |
| (219) 267-1729 |
| Full Name | Klockow Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 118 S Van Rensselaer St, Rensselaer, Indiana |
| Authorized Official Name and Position | Raymond Gordon Klockow (PRESIDENT) |
| Authorized Official Contact | 2198691097 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Klockow Pc 118 S Van Rensselaer St Rensselaer IN 47978-2815 Ph: (219) 869-1097 | Klockow Pc 118 S Van Rensselaer St Rensselaer IN 47978-2815 Ph: (219) 869-1097 |
| NPI Number | 1861861254 |
|---|---|
| Provider Enumeration Date | 09/16/2015 |
| Last Update Date | 09/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861861254 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 54000437A (Indiana) | Primary |
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