NPIMap

Organization Active NPI

Indy East Periodontics PC

  • Periodontics
  • Indianapolis, IN
National Provider Identifier
1164726832
Registry record updated Jan 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
INDY EAST PERIODONTICS PC
Practice address
115 N Shortridge Rd Ste 100
Indianapolis, IN 46219-4917
Phone
(317) 357-2235
Fax
(317) 357-2210
NPI assigned
Jan 10, 2011
Last updated
Jan 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2011

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

Authorized official

Name
Dr. Stephen C. Koehler, DDS, MSD
Title
Periodontist
Phone
(317) 357-2235

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X IN Primary

Addresses

Primary practice location

115 N Shortridge Rd Ste 100
Indianapolis, IN 46219-4917

Mailing address

115 N Shortridge Rd Ste 100
Indianapolis, IN 46219-4917
Phone (317) 357-2235

National Provider Directory

National Provider Directory

Locations

115 N Shortridge Rd
Ste 100
Indianapolis, IN 46219
Phone (317) 357-2235

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294617600000",
    "number": "1164726832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N SHORTRIDGE RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194917",
            "telephone_number": "317-357-2235",
            "fax_number": "317-357-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N SHORTRIDGE RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194917",
            "telephone_number": "317-357-2235",
            "fax_number": "317-357-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDY EAST PERIODONTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-10",
        "last_updated": "2011-01-10",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "317-357-2235",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "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 Jan 10, 2011; 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.