# KIDS & ADULT DENTAL SOUTHPORT INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KIDS & ADULT DENTAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689553018
- **Authorized official:** BRANDI BIBB (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (317) 991-4725

## Contact information

- **Practice address:** 7001 MADISON AVE, SOUTHPORT, IN 46227-5203
- **Practice address phone:** (317) 991-4725
- **Practice address fax:** (317) 986-4097
- **Mailing address:** 7001 MADISON AVE, SOUTHPORT, IN 46227-5203
- **Mailing address phone:** (317) 991-4725
- **Mailing address fax:** (317) 986-4097

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 08/29/2025
- **Last updated:** 12/11/2025