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General NPI Number Information
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NPI Number | 1770401366
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Entity Type | Individual
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Provider Name | HIBA ALI DMD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 3900 N BAY DR
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City | RACINE
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State | WI
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Zip | 53402-3632
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Country | US
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Telephone | 262-639-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 2521 W MAPLE LEAF LN UNIT 107
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City | OAK CREEK
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State | WI
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Zip | 53154-1548
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Country | US
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Telephone | 414-252-9803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6002282-15
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License Number State | WI
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