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General NPI Number Information
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NPI Number | 1699590174
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Entity Type | Organization
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Legal Business Name | MAHADEEP VIRK DMD, MSD & ELLEN POLSKY DDS
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 22530 SE 64TH PL STE 130
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City | ISSAQUAH
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State | WA
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Zip | 98027-5353
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Country | US
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Telephone | 253-848-4000
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Fax | 253-604-4130
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Provider Business Mailing Address
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Address Line | PO BOX 460
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City | PUYALLUP
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State | WA
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Zip | 98371-0047
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Country | US
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Telephone | 253-848-4000
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Fax | 253-604-4130
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ANGIE METZGER
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Credential |
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Telephone | 253-219-5730
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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