# HEAD AND NECK DIAGNOSTIC ASSOCIATES, P.C.

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

## Provider details

- **NPI number:** 1205884079
- **Authorized official:** RAYMOND GORDON KLOCKOW D.D.S. (PRESIDENT)
- **Authorized official phone:** (800) 711-8885

## Contact information

- **Practice address:** 331 E AMSLER RD, RENSSELAER, IN 47978-8591
- **Practice address phone:** (800) 711-8885
- **Practice address fax:** (219) 866-8658
- **Mailing address:** 331 E AMSLER RD, RENSSELAER, IN 47978-8591
- **Mailing address phone:** (800) 711-8885
- **Mailing address fax:** (219) 866-8658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 54000437 | IN | Yes |

## Other

- **Enumeration date:** 05/04/2006
- **Last updated:** 08/22/2020