Organization
KIDS & ADULT DENTAL SOUTHPORT INC
Active
Other names
KIDS & ADULT DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDI BIBB (PRACTICE ADMINISTRATOR)
(317) 991-4725
Entity
Organization
Contact information
Practice address
7001 MADISON AVE, SOUTHPORT, IN 46227-5203
(317) 991-4725
(317) 986-4097
Mailing address
7001 MADISON AVE, SOUTHPORT, IN 46227-5203
(317) 991-4725
(317) 986-4097
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/29/2025
Last updated
12/11/2025
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