# KLUTH FAMILY DENTISTRY INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053402198
- **Authorized official:** MS. BETTY J SIZELOVE (OFFICE MANAGER)
- **Authorized official phone:** (765) 724-7729

## Contact information

- **Practice address:** 2204 S PARK AVE, ALEXANDRIA, IN 46001-8059
- **Practice address phone:** (765) 724-7729
- **Practice address fax:** (765) 724-9519
- **Mailing address:** 2204 S PARK AVE, ALEXANDRIA, IN 46001-8059
- **Mailing address phone:** (765) 724-7729
- **Mailing address fax:** (765) 724-9519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009126 | IN | Yes |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000089901 | ANTHEM BLUE CROSS | IN |
| 01 | — | 000000189293 | ANTHEM BLUE CROSS BLUE SH | IN |
| 01 | — | 784991 | MILITARY | IN |
| 05 | — | 9177506 | — | IL |