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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