Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southport Periodontics

Organization Periodontics · NPI 1679064901

Southport Periodontics is a Periodontics in Kenosha, Wisconsin. Registered with an NPI since 2018.

In the registry since
2018

Practice location Address checks out

5021 Washington Rd
Kenosha, WI 53144
Phone: (262) 654-6770
Fax: (262) 654-6727
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X

Record details

NPI number1679064901
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Patricia Jenkins — Manager · (262) 654-6770
NPI enumeratedMay 22, 2018
Last updated in NPPESMay 22, 2018
Mailing address5021 Washington Rd, Kenosha, WI 53144-4292

Other providers in Kenosha