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Organization
BLOOMINGTON FAMILY DENTAL
Active
Organization
BLOOMINGTON FAMILY DENTAL
Active
Other names
Bloomington Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN EDWARD KLOBOVES DDS (DENTIST)
(812) 824-1600
Entity
Organization
Contact information
Practice address
4000 SOUTH OLD STATE RD US 37, BLOOMINGTON, IN 47401-7412
(812) 824-1600
(812) 824-1615
Mailing address
4000 S. OLD STATE RD US 37, BLOOMINGTON, IN 47401-7412
(812) 824-1600
(812) 824-1615
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010746B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200522010
—
IN
Enumeration date
11/11/2009
Last updated
11/11/2009
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