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Organization
KLOCKOW PC
Active
Organization
KLOCKOW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND GORDON KLOCKOW DDS (PRESIDENT)
(219) 869-1097
Entity
Organization
Contact information
Practice address
118 S VAN RENSSELAER ST, RENSSELAER, IN 47978-2815
(219) 869-1097
(219) 267-1729
Mailing address
118 S VAN RENSSELAER ST, RENSSELAER, IN 47978-2815
(219) 869-1097
(219) 267-1729
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
54000437A
IN
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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