Healthcare Provider Details

I. General information

NPI: 1780121673
Provider Name (Legal Business Name): COVINGTON ORTHODONTICS AND PEDIATRIC DENTISTRY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 SE 270TH PL STE 102
COVINGTON WA
98042-5431
US

IV. Provider business mailing address

17121 SE 270TH PL STE 102
COVINGTON WA
98042-5431
US

V. Phone/Fax

Practice location:
  • Phone: 253-533-2999
  • Fax:
Mailing address:
  • Phone: 253-533-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MAHADEEP VIRK
Title or Position: OWNER
Credential: DDS
Phone: 206-786-5351