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Organization
WISCONSIN SMILES
Active
Organization
WISCONSIN SMILES
Active
Parent organization
WISCONSIN SMILES
Other names
American Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
WISCONSIN SMILES
Authorized official
DR. HIDAYATHULLA KHAN DMD (PRESIDENT)
(224) 766-9876
Entity
Organization
Contact information
Practice address
6719 W CAPITOL DR, MILWAUKEE, WI 53216-2041
(414) 464-6300
(414) 464-2874
Mailing address
6719 W CAPITOL DR, MILWAUKEE, WI 53216-2041
(414) 464-6300
(414) 464-2874
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699128082
CMS-NPI
—
Enumeration date
10/08/2020
Last updated
10/08/2020
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