Southeast Dental Group
NPI #1114031952 in Indianapolis, Indiana
Provider Information
- NPI Number
- 1114031952
- Entity Type
- Organization
- Organization Name
- Southeast Dental Group
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Aug 18, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 6020 SOUTHEASTERN AVE
- City
- Indianapolis
- State
- Indiana
- ZIP Code
- 46203-5611
- Phone
- (317) 359-1754
Authorized Official
- Name
- MARK V BOHNERT, D.D.S.
- Title
- PRESIDENT/OWNER
- Phone
- (317) 359-1754
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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