Provider Demographics
NPI:1063631885
Name:VIRK, AMANDEEP BRAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:BRAR
Last Name:VIRK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33261 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1129
Mailing Address - Country:US
Mailing Address - Phone:510-684-6300
Mailing Address - Fax:510-441-2082
Practice Address - Street 1:33261 FALCON DRIVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-1129
Practice Address - Country:US
Practice Address - Phone:510-684-6300
Practice Address - Fax:510-441-2082
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist