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General NPI Number Information
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NPI Number | 1780121673
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Entity Type | Organization
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Legal Business Name | COVINGTON ORTHODONTICS AND PEDIATRIC DENTISTRY L.L.C.
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 17121 SE 270TH PL STE 102
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City | COVINGTON
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State | WA
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Zip | 98042-5431
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Country | US
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Telephone | 253-533-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 17121 SE 270TH PL STE 102
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City | COVINGTON
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State | WA
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Zip | 98042-5431
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Country | US
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Telephone | 253-533-2999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAHADEEP VIRK
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Credential | DDS
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Telephone | 206-786-5351
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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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