# SOUTHPORT SMILES FAMILY AND COSMETIC DENTISTRY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Southport Smiles Family and Cosmetic Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457908667
- **Authorized official:** BETHANY GEYMAN DDS (DENTIST)
- **Authorized official phone:** (317) 507-1568

## Contact information

- **Practice address:** 1505 E SOUTHPORT RD, INDIANAPOLIS, IN 46227-5303
- **Practice address phone:** (317) 784-2266
- **Mailing address:** 1505 E SOUTHPORT RD, INDIANAPOLIS, IN 46227-5303
- **Mailing address phone:** (317) 784-2266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/22/2019
- **Last updated:** 08/22/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1558498238 | NPI | IN |