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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