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Organization
SOUTHPORT DENTAL, P.C.
Active
Organization
SOUTHPORT DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN M MILLS D.D.S (DENTIST)
(317) 883-3300
Entity
Organization
Contact information
Practice address
8028 SOUTH EMERSON AVE, SUITE A, INDIANAPOLIS, IN 46237-9301
(317) 883-3300
(317) 889-3348
Mailing address
8028 SOUTH EMERSON AVE, SUITE A, INDIANAPOLIS, IN 46237
(317) 883-3300
(317) 889-3348
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010416
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1368963
UNITED CONCORDIA
IN
Enumeration date
04/12/2007
Last updated
08/22/2020
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