Bloomington Family Dental

Primary specialty

DentistTaxonomy code 122300000X

License

12010746B Issued in IN

Legal business name

BLOOMINGTON FAMILY DENTAL

Doing business as

Bloomington Family Dental

Practice address

4000 South Old State Rd US 37
Bloomington, IN 47401-7412

Phone

(812) 824-1600

Fax

(812) 824-1615

NPI assigned

Nov 11, 2009

Last updated

Nov 11, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ryan Edward Kloboves, DDS

Title

Dentist

Phone

(812) 824-1600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bloomington Family Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1851628903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 S. OLD STATE RD US 37",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017412",
            "telephone_number": "812-824-1600",
            "fax_number": "812-824-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 SOUTH OLD STATE RD US 37",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017412",
            "telephone_number": "812-824-1600",
            "fax_number": "812-824-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "KLOBOVES",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "812-824-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010746B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200522010",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloomington Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.