MEDICARE: DR. SHIREEN G CHAWLA DDS

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	60878336	WA

General Provider Information

NPI Number	:	1679052062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIREEN G CHAWLA DDS

Provider Business Mailing Address
First Line	:	14510 NE 11TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98684-3673
Country	:	US
Telephone Number	:	360-907-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 SW 9TH AVE
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-3266
Country	:	US
Telephone Number	:	360-436-6969
Fax Number	:

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

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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