Provider Demographics
NPI:1568092021
Name:CHAVAN, HARSHALA
Entity Type:Individual
Prefix:DR
First Name:HARSHALA
Middle Name:
Last Name:CHAVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 8TH AVE N APT 710
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4795
Mailing Address - Country:US
Mailing Address - Phone:310-418-6806
Mailing Address - Fax:
Practice Address - Street 1:2500 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5202
Practice Address - Country:US
Practice Address - Phone:773-360-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0324621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice