Organization
WISCONSIN SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HIDAYATHULLA SMILE KHAN DMD (OWNER)
(224) 443-4988
Entity
Organization
Contact information
Practice address
4915 WASHINGTON AVE STE B, RACINE, WI 53406-4249
(262) 619-1949
Mailing address
4915 WASHINGTON AVE STE B, RACINE, WI 53406-4249
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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