Organization
HEAD AND NECK DIAGNOSTIC ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND GORDON KLOCKOW D.D.S. (PRESIDENT)
(800) 711-8885
Entity
Organization
Contact information
Practice address
331 E AMSLER RD, RENSSELAER, IN 47978-8591
(800) 711-8885
(219) 866-8658
Mailing address
331 E AMSLER RD, RENSSELAER, IN 47978-8591
(800) 711-8885
(219) 866-8658
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
54000437
IN
Other
Enumeration date
05/04/2006
Last updated
08/22/2020
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