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General NPI Number Information
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NPI Number | 1659744506
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Entity Type | Organization
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Legal Business Name | DENTAL CASTLE INC
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Dates
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Enumeration Date | 11/01/2015
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Last Update Date | 11/01/2015
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Provider Practice Location Address
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Address Line | 2669 N SWAN BLVD
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City | WAUWATOSA
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State | WI
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Zip | 53226-1800
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Country | US
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Telephone | 414-258-2216
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Fax | 414-258-9466
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Provider Business Mailing Address
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Address Line | 2669 N SWAN BLVD
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City | WAUWATOSA
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State | WI
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Zip | 53226-1800
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Country | US
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Telephone | 414-258-2216
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Fax | 414-258-9466
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WAEL SHAHSHOUH
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Credential |
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Telephone | 414-258-2216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029338
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License Number State | WI
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