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Organization
RACINE PERIODONTICS AND IMPLANT DENTISTRY LTD
Active
Organization
RACINE PERIODONTICS AND IMPLANT DENTISTRY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADRIAN RIVAS DMD (OWNER)
(305) 807-9082
Entity
Organization
Contact information
Practice address
255 HAVENWOOD DR, LAKE GENEVA, WI 53147-1988
(262) 248-8505
Mailing address
4715 JAMES AVE, RACINE, WI 53402-2642
(305) 807-9082
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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