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General NPI Number Information
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NPI Number | 1689219933
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Entity Type | Organization
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Legal Business Name | MAHADEEP S VIRK DMD & ELLEN POLSKY DDS, P.L.L.C.
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 2702 S 42ND ST STE 106
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City | TACOMA
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State | WA
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Zip | 98409-7315
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Country | US
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Telephone | 844-726-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 10317 122ND ST E STE B
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City | PUYALLUP
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State | WA
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Zip | 98374-2632
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Country | US
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Telephone | 844-726-1800
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Fax |
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Authorized Official
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Title or Position | OFFICE STAFF
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Name | JESSICA GRISHAM
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Credential |
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Telephone | 844-726-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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