| Bloomington Family Dental | |
|
4000 South Old State Rd Us 37 Bloomington IN 47401-7412 | |
| (812) 824-1600 | |
| (812) 824-1615 |
| Full Name | Bloomington Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 4000 South Old State Rd Us 37, Bloomington, Indiana |
| Authorized Official Name and Position | Ryan Edward Kloboves (DENTIST) |
| Authorized Official Contact | 8128241600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloomington Family Dental 4000 S. Old State Rd Us 37 Bloomington IN 47401-7412 Ph: (812) 824-1600 | Bloomington Family Dental 4000 South Old State Rd Us 37 Bloomington IN 47401-7412 Ph: (812) 824-1600 |
| NPI Number | 1851628903 |
|---|---|
| Provider Enumeration Date | 11/11/2009 |
| Last Update Date | 11/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851628903 | NPI | - | NPPES |
| 200522010 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12010746B (Indiana) | Primary |
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