# SOUTHPORT DENTAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376767525
- **Authorized official:** DR. RYAN M MILLS D.D.S (DENTIST)
- **Authorized official phone:** (317) 883-3300

## Contact information

- **Practice address:** 8028 SOUTH EMERSON AVE, SUITE A, INDIANAPOLIS, IN 46237-9301
- **Practice address phone:** (317) 883-3300
- **Practice address fax:** (317) 889-3348
- **Mailing address:** 8028 SOUTH EMERSON AVE, SUITE A, INDIANAPOLIS, IN 46237
- **Mailing address phone:** (317) 883-3300
- **Mailing address fax:** (317) 889-3348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010416 | IN | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1368963 | UNITED CONCORDIA | IN |