Provider Demographics
NPI:1346786985
Name:BHALLA, ANNU
Entity Type:Individual
Prefix:
First Name:ANNU
Middle Name:
Last Name:BHALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 N CORTARO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7304
Mailing Address - Country:US
Mailing Address - Phone:520-477-2233
Mailing Address - Fax:
Practice Address - Street 1:8250 N CORTARO RD STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7304
Practice Address - Country:US
Practice Address - Phone:520-477-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist