Healthcare Provider Details

I. General information

NPI: 1891905337
Provider Name (Legal Business Name): GEETIKA CHAWLA BDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. GEETIKA CHAWLA

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/25/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SE 136TH AVE STE 103
VANCOUVER WA
98684-6908
US

IV. Provider business mailing address

5313 NW BARLOW ST
CAMAS WA
98607-7627
US

V. Phone/Fax

Practice location:
  • Phone: 360-836-8398
  • Fax: 360-836-8298
Mailing address:
  • Phone: 360-921-6141
  • Fax: 360-836-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8900
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number8900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: