NPIMap

Organization Active NPI

Bright Side Dental - Indianapolis Keystone Avenue LLC

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1336525567
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12011992A Issued in IN
Legal business name
BRIGHT SIDE DENTAL - INDIANAPOLIS KEYSTONE AVENUE LLC
Practice address
7102 N Keystone Ave
Indianapolis, IN 46240-3242
Phone
(317) 731-6636
Fax
(317) 731-6569
NPI assigned
Aug 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Abraham Gershonowicz, DDS
Title
Owner
Phone
(317) 731-6636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12011992A IN Primary

Addresses

Primary practice location

7102 N Keystone Ave
Indianapolis, IN 46240-3242

Mailing address

7102 N Keystone Ave
Indianapolis, IN 46240-3242
Phone (317) 731-6636

National Provider Directory

National Provider Directory

Locations

7102 N Keystone Ave
Indianapolis, IN 46240
Phone (317) 731-6636

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1336525567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7102 N KEYSTONE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462403242",
            "telephone_number": "317-731-6636",
            "fax_number": "317-731-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7102 N KEYSTONE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462403242",
            "telephone_number": "317-731-6636",
            "fax_number": "317-731-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT SIDE DENTAL - INDIANAPOLIS KEYSTONE AVENUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-11",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "GERSHONOWICZ",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-731-6636",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011992A",
            "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 Aug 11, 2015; 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.