# KLOCKOW PC

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

## Provider details

- **NPI number:** 1861861254
- **Authorized official:** DR. RAYMOND GORDON KLOCKOW DDS (PRESIDENT)
- **Authorized official phone:** (219) 869-1097

## Contact information

- **Practice address:** 118 S VAN RENSSELAER ST, RENSSELAER, IN 47978-2815
- **Practice address phone:** (219) 869-1097
- **Practice address fax:** (219) 267-1729
- **Mailing address:** 118 S VAN RENSSELAER ST, RENSSELAER, IN 47978-2815
- **Mailing address phone:** (219) 869-1097
- **Mailing address fax:** (219) 267-1729

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 54000437A | IN | Yes |

## Other

- **Enumeration date:** 09/16/2015
- **Last updated:** 09/16/2015