SOUTHPORT PERIODONTICS

KENOSHA, WI
NPI1679064901
Entity TypeOrganization
Authorized ContactPATRICIA JENKINS
Manager
262-654-6770
Organization Subpart ?No
Primary Taxonomy1223P0300X Dentist, Periodontics
Enumeration Date2018-05-22
Last Update Date2018-05-22
Business Address
SOUTHPORT PERIODONTICS
5021 WASHINGTON RD
KENOSHA, WI 53144
Phone number: 262-654-6770
Mailing Address
SOUTHPORT PERIODONTICS
5021 WASHINGTON RD
KENOSHA, WI 53144-4292
Phone number: 262-654-6770
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