Southport Periodontics
NPI #1679064901 in Kenosha, Wisconsin
Provider Information
- NPI Number
- 1679064901
- Entity Type
- Organization
- Organization Name
- Southport Periodontics
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- May 22, 2018
- Last Updated
- May 22, 2018
Practice Location
Authorized Official
- Name
- PATRICIA JENKINS
- Title
- MANAGER
- Phone
- (262) 654-6770
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
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