| NPI | 1033177274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND GORDON KLOCKOW President 219-866-7117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 5400-1122) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-08-22 |