Active NPI
Lak East Indy Dental LLC
- Dentist
- Indianapolis, IN
National Provider Identifier
1053225094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- LAK EAST INDY DENTAL LLC
- Practice address
- 115 N Shortridge Rd Ste 200
Indianapolis, IN 46219-4917 - Phone
- (317) 353-1062
- NPI assigned
- Sep 29, 2026
- Last updated
- Sep 29, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jacqueline Sue Newport
- Title
- Office Manager
- Phone
- (317) 353-1062
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NU | Primary |
Addresses
Primary practice location
115 N Shortridge Rd Ste 200
Indianapolis, IN 46219-4917
Mailing address
115 N Shortridge Rd Ste 200
Indianapolis, IN 46219-4917
Phone (317) 353-1062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790640000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790640000000",
"number": "1053225094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 N SHORTRIDGE RD STE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194917",
"telephone_number": "317-353-1062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 N SHORTRIDGE RD STE 200",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194917",
"telephone_number": "317-353-1062"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAK EAST INDY DENTAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-29",
"last_updated": "2026-09-29",
"certification_date": "2026-09-29",
"status": "A",
"authorized_official_last_name": "NEWPORT",
"authorized_official_first_name": "JACQUELINE",
"authorized_official_middle_name": "SUE",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "317-353-1062"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.