Southeast Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTHEAST DENTAL GROUP

Practice address

6020 Southeastern Ave
Indianapolis, IN 46203-5611

Phone

(317) 359-1754

Fax

(317) 357-3663

NPI assigned

Aug 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark V Bohnert, D.D.S.NPI 1346354164

Title

President/Owner

Phone

(317) 359-1754

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Victor Bohnert, D.D.S.

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1346354164
  NPD (past) Authorized official
• Laura K. Geiger, D.D.S.

  • Dentist
  • Indianapolis, IN
  • NPI 1194167874
  NPD (past)
• Kathleen Jones, DDS

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1710248067
  NPD (past)
• Christopher William Shorey, D.D.S.

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1639283468
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114031952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 SOUTHEASTERN AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462035611",
            "telephone_number": "317-359-1754",
            "fax_number": "317-357-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6020 SOUTHEASTERN AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462035611",
            "telephone_number": "317-359-1754",
            "fax_number": "317-357-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOHNERT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "317-359-1754",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Emerson Pain Management Center
• South Emerson Surgery Center, LLC
• South Indy Family Practive
• South Indy MRI and Rehab Services
• Southeast Anesthesiologists, Inc.
• Southeast Family Physicians, PC
• Southeast Neighborhood School of Excellence, Inc.
• Southeast Surgery Center LLC (Indiana Orthopaedic Surgery Center)
• Brooke S. Southerland, PA-C
• Jara Lynn Southerland, NP

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.