Healthcare Provider Details

I. General information

NPI: 1811805567
Provider Name (Legal Business Name): BLOOM DENTAL - GEIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7962 OAKLANDON RD STE 105
INDIANAPOLIS IN
46236-7502
US

IV. Provider business mailing address

435 VIRGINIA AVE UNIT 1900
INDIANAPOLIS IN
46203-1964
US

V. Phone/Fax

Practice location:
  • Phone: 317-823-1780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HALEY LONG
Title or Position: RCM MANAGER
Credential:
Phone: 317-313-8457