MEDICARE: DR. ISHITA BHALLA BDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE61190078	WA

General Provider Information

NPI Number	:	1578266037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISHITA BHALLA BDS

Provider Business Mailing Address
First Line	:	2101 NE 129TH ST STE 101
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98686-3267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 NE 129TH ST STE 101
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98686-3267
Country	:	US
Telephone Number	:	360-574-4574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	01/29/2026

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