Southport Dental, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010416 Issued in IN

Legal business name

SOUTHPORT DENTAL, P.C.

Practice address

8028 South Emerson Ave
Suite a
Indianapolis, IN 46237-9301

Phone

(317) 883-3300

Fax

(317) 889-3348

NPI assigned

Apr 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ryan M Mills, D.D.SNPI 1376630129

Title

Dentist

Phone

(317) 883-3300

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Ryan M Mills, D.D.S

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1376630129
  NPD (past) Authorized official

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376767525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8028 SOUTH EMERSON AVE",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46237",
            "telephone_number": "317-883-3300",
            "fax_number": "317-889-3348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8028 SOUTH EMERSON AVE",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462379301",
            "telephone_number": "317-883-3300",
            "fax_number": "317-889-3348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "317-883-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1368963",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Hospitality Incorporated
• Southern Medical Corporation PC
• Thomas E Southern, MD
• Southpointe Pediatrics, PC
• Southport Adult Day Center
• Southport Smiles Family and Cosmetic Dentistry
• Southside Emergency Associates
• Southside Eye Associates
• Southside Family Medical Group, LLC
• Southside Family Physicians, Inc

• 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.