Organization
SOUTHEAST DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK V BOHNERT D.D.S. (PRESIDENT/OWNER)
(317) 359-1754
Entity
Organization
Contact information
Practice address
6020 SOUTHEASTERN AVE, INDIANAPOLIS, IN 46203-5611
(317) 359-1754
(317) 357-3663
Mailing address
6020 SOUTHEASTERN AVE, INDIANAPOLIS, IN 46203-5611
(317) 359-1754
(317) 357-3663
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/18/2006
Last updated
08/22/2020
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