Organization
SOUTHWEST DENTAL GROUP, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD L. DEFURIO D.D.S. (OWNER)
(262) 632-3156
Entity
Organization
Contact information
Practice address
2601 TAYLOR AVE, RACINE, WI 53403-2865
(262) 632-3156
(262) 632-3063
Mailing address
2601 TAYLOR AVE, RACINE, WI 53403-2865
(262) 632-3156
(262) 632-3063
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/23/2007
Last updated
08/22/2020
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