Provider Demographics
NPI:1871635573
Name:KLUTH, JONI L (DDS)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:L
Last Name:KLUTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 OAK COVE LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9415
Mailing Address - Country:US
Mailing Address - Phone:317-877-0420
Mailing Address - Fax:
Practice Address - Street 1:2204 S PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8059
Practice Address - Country:US
Practice Address - Phone:765-724-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000189293OtherANTHEM BLUE CROSS