MEDICARE: AMANDEEP BRAR VIRK D.D.S.INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	55207	CA

General Provider Information

NPI Number	:	1013184365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDEEP BRAR VIRK D.D.S.INC

Provider Business Mailing Address
First Line	:	2 UNION SQ
Second Line	:	SUITE#230
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-489-5000
Fax Number	:	510-489-5002

Provider Business Practice Location Address
First Line	:	2 UNION SQ
Second Line	:	SUITE#230
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-489-5000
Fax Number	:	510-489-5002

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMANDEEP BRAR VIRK
Credential	:	D.D.S.
Telephone Number	:	510-489-5000

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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