Organization
SOUTHPORT SMILES FAMILY AND COSMETIC DENTISTRY
Active
Other names
Southport Smiles Family and Cosmetic Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BETHANY GEYMAN DDS (DENTIST)
(317) 507-1568
Entity
Organization
Contact information
Practice address
1505 E SOUTHPORT RD, INDIANAPOLIS, IN 46227-5303
(317) 784-2266
Mailing address
1505 E SOUTHPORT RD, INDIANAPOLIS, IN 46227-5303
(317) 784-2266
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558498238
NPI
IN
Enumeration date
08/22/2019
Last updated
08/22/2019
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