Provider Demographics
NPI:1801638218
Name:ALLA, HARSHITHA (DDS)
Entity type:Individual
Prefix:DR
First Name:HARSHITHA
Middle Name:
Last Name:ALLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HARSHITHA
Other - Middle Name:
Other - Last Name:SUDHAKARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7417 NW 159TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5987
Mailing Address - Country:US
Mailing Address - Phone:610-653-5984
Mailing Address - Fax:
Practice Address - Street 1:907 LINCOLNWAY S
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-1707
Practice Address - Country:US
Practice Address - Phone:260-800-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014470A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist