OrganizationActive
Southport Periodontics
NPI 1679064901 · Periodontics · Kenosha, WI
Southport Periodontics is a Periodontics organization in Kenosha, WI (NPI 1679064901).
Provider details
- NPI number
- 1679064901
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Organization subpart
- No
- Authorized official
- Patricia Jenkins, Manager(262) 654-6770
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(68/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5021 Washington Rd
Kenosha, WI 53144
Phone: (262) 654-6770
Fax: (262) 654-6727
Street-level locationGet directions
Mailing address
5021 Washington Rd
Kenosha, WI 53144-4292
Registry dates
- Enumerated
- 2018-05-22
- Last updated
- 2018-05-22
Frequently asked questions
- What is Southport Periodontics's NPI number?
- Southport Periodontics's National Provider Identifier (NPI) is 1679064901, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Southport Periodontics?
- Southport Periodontics is classified in the NPPES registry as Periodontics (Dental Providers).
- Where is Southport Periodontics located?
- Southport Periodontics's practice location on file with NPPES is 5021 Washington Rd, Kenosha, WI 53144.
- What is Southport Periodontics's phone number?
- The practice phone number listed in the NPPES registry for Southport Periodontics is (262) 654-6770.
- Who is the authorized official for Southport Periodontics?
- The authorized official listed on Southport Periodontics's NPPES record is Patricia Jenkins, Manager. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Southport Periodontics's NPI active?
- Yes — Southport Periodontics's NPI (1679064901) is active in the NPPES registry as of the last update on 2018-05-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.