Midwest Periodontal and Oral Reconstruction, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MIDWEST PERIODONTAL AND ORAL RECONSTRUCTION, P.C.

Doing business as

Sonrisa-A Periodental Spa

Practice address

508 Indiana Ave
Indianapolis, IN 46202-3106

Phone

(317) 269-0402

Fax

(317) 269-0405

NPI assigned

Nov 6, 2006

Last updated

Jul 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brigitte Mills

Title

Director of Business Affairs

Phone

(317) 269-0402

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Sonrisa-A Periodental Spa Doing business as

Locations

Practitioners 4

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.

• Kathleen Judith Beache, DDS

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1154546489
  NPD (past)
• Jeanette D Sabir-Holloway, D.D.S.

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1134208465
  NPD (past)
• Katherine Elizabeth So, D.D.S.

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1366707473
  NPD (past)
• Stephen B Towns, D.D.S.

  • Periodontics
  • Indianapolis, IN
  • NPI 1790864445
  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1649359886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 INDIANA AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023106",
            "telephone_number": "317-269-0402",
            "fax_number": "317-269-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 INDIANA AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023106",
            "telephone_number": "317-269-0402",
            "fax_number": "317-269-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PERIODONTAL AND ORAL RECONSTRUCTION, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "BRIGITTE",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS AFFAIRS",
        "authorized_official_telephone_number": "317-269-0402"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200533430A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonrisa-A Periodental Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Jul 2, 2008; 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.