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General NPI Number Information
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NPI Number | 1578644100
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Entity Type | Organization
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Legal Business Name | MAHADEEP VIRK DMD EVERETT, PS
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 8625 EVERGREEN WAY 212
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City | EVERETT
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State | WA
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Zip | 98208
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Country | US
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Telephone | 425-438-8584
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Fax | 425-438-2625
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Provider Business Mailing Address
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Address Line | 8625 EVERGREEN WAY 212
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City | EVERETT
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State | WA
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Zip | 98208
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Country | US
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Telephone | 425-438-8584
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Fax | 425-438-2625
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MONA L HORN
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Credential |
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Telephone | 425-438-8584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8144
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License Number State | WA
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