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General NPI Number Information
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NPI Number | 1437774163
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Entity Type | Individual
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Provider Name | ISHA WATTS KHULLAR
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 7401 N UNIVERSITY DR STE 207
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City | TAMARAC
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State | FL
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Zip | 33321-2934
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Country | US
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Telephone | 954-721-6950
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Fax |
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Provider Business Mailing Address
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Address Line | 4786 W COMMERCIAL BLVD
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City | TAMARAC
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State | FL
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Zip | 33319-2878
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Country | US
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Telephone | 754-304-6468
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27243
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | RES004820
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License Number State | OH
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