Organization
KLUTH FAMILY DENTISTRY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTY J SIZELOVE (OFFICE MANAGER)
(765) 724-7729
Entity
Organization
Contact information
Practice address
2204 S PARK AVE, ALEXANDRIA, IN 46001-8059
(765) 724-7729
(765) 724-9519
Mailing address
2204 S PARK AVE, ALEXANDRIA, IN 46001-8059
(765) 724-7729
(765) 724-9519
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009126
IN
Other
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
Enumeration date
09/27/2006
Last updated
08/22/2020
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