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SOUTHPORT PERIODONTICS
NPI 1679064901
Dentist - Periodontics in Kenosha, WI

Active since May 22, 2018
5021 WASHINGTON RD, KENOSHA, WI 53144(262) 654-6770(262) 654-6727 Get Directions Write a Review

NPPES record last updated: May 22, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Southport Periodontics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHPORT PERIODONTICS (NPI 1679064901) is a healthcare organization registered as a periodontics in Kenosha, Wisconsin and active in the NPI registry since May 2018. The organization lists Patricia Jenkins, Manager, as its authorized official.

NPPES Registry Identity

NPI1679064901
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameSOUTHPORT PERIODONTICS
Location Address5021 WASHINGTON RDKenosha, WI 53144
Mailing Address5021 Washington RdKenosha, WI 53144-4292 · (262) 654-6770 · Fax (262) 654-6727
Phone(262) 654-6770
Fax(262) 654-6727
Organization SubpartNo
Authorized OfficialPatricia JenkinsManager · (262) 654-6770
Enumeration DateMay 22, 2018
✔ NPI 1679064901 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
5021 WASHINGTON RD, Kenosha, WI 53144
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DEAN TIBORIS DMD
Oral & Maxillofacial Surgery
5021 WASHINGTON RD
KENOSHA, WI 53144
Kenosha County (262) 654-6770
DR. JOHN M LINDELL DDS
Dentist (Endodontics)
5021 WASHINGTON RD
KENOSHA, WI 53144
Kenosha County (262) 632-5455
IDS
Dentist (Endodontics)
5021 WASHINGTON RD
KENOSHA, WI 53144
Kenosha County (262) 654-6770
SARAH NICOLE HYLINSKI FNP
Nurse Practitioner
5021 WASHINGTON RD
KENOSHA, WI 53144
Kenosha County (262) 654-6770
WISNOVA LLC
Dentist (Endodontics)
5021 WASHINGTON RD
KENOSHA, WI 53144
Kenosha County (262) 632-5455

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southport Periodontics's NPI number?

The NPI number for Southport Periodontics is 1679064901. It was assigned to this organization in the NPPES registry on May 22, 2018.

Where is Southport Periodontics located?

Southport Periodontics is located at 5021 Washington Rd, Kenosha, WI 53144. The listed phone number is (262) 654-6770.

What is Southport Periodontics's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Southport Periodontics was last updated on May 22, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.