Provider Demographics
NPI:1538518105
Name:GEETIKA CHAWLA BDS MDS PLLC
Entity Type:Organization
Organization Name:GEETIKA CHAWLA BDS MDS PLLC
Other - Org Name:AYUR TMJ AND CRANIOFACIAL PAIN CLINIC & DENTAL SLEEP MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. GEETIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS MDS
Authorized Official - Phone:360-836-8398
Mailing Address - Street 1:217 SE 136TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6907
Mailing Address - Country:US
Mailing Address - Phone:360-836-8398
Mailing Address - Fax:360-836-8298
Practice Address - Street 1:217 SE 136TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6907
Practice Address - Country:US
Practice Address - Phone:360-836-8398
Practice Address - Fax:360-836-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8900122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty