Provider Demographics
NPI:1679052062
Name:CHAWLA, SHIREEN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIREEN
Middle Name:G
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14510 NE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3673
Mailing Address - Country:US
Mailing Address - Phone:360-907-6600
Mailing Address - Fax:
Practice Address - Street 1:1710 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-3266
Practice Address - Country:US
Practice Address - Phone:360-436-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60878336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist