Healthcare Provider Details

I. General information

NPI: 1053154823
Provider Name (Legal Business Name): STEVEN MAH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 S EMERSON AVE
INDIANAPOLIS IN
46237-1970
US

IV. Provider business mailing address

5406 S EMERSON AVE
INDIANAPOLIS IN
46237-1970
US

V. Phone/Fax

Practice location:
  • Phone: 317-780-7777
  • Fax:
Mailing address:
  • Phone: 317-780-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014463A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: