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General NPI Number Information
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NPI Number | 1346732153
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Entity Type | Individual
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Provider Name | AMRITTEJ SINGH VIRK
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 630 N KIMBALL AVE STE 110
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 817-251-9985
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Fax |
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Provider Business Mailing Address
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Address Line | 630 N KIMBALL AVE STE 110
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6887
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Country | US
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Telephone | 817-251-9985
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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 | 34421
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9990
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | 34421
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License Number State | TX
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