=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972204733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELICATE SMILES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2023
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W SILVER SPRING DR STE 320
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-5059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-332-1808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2728 RED FAWN CT
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-577-0282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HASSAN ALSHEHABI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-577-0282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------