Organization
ROBERT H SOUTHWORTH DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT HURD SOUTHWORTH DDS (PRESIDENT OWNER)
(715) 842-1935
Entity
Organization
Contact information
Practice address
609 JACKSON ST, WAUSAU, WI 54403-5550
(715) 842-1935
(715) 842-0334
Mailing address
609 JACKSON ST, WAUSAU, WI 54403-5550
(715) 842-1935
(715) 842-0334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001628-015
WI
Other
Enumeration date
08/29/2006
Last updated
08/22/2020
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