| NPI | 1457908667 |
|---|---|
| Doing Business As | SOUTHPORT SMILES FAMILY AND COSMETIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | BETHANY GEYMAN Dentist 317-507-1568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |