Provider Demographics
NPI:1093914871
Name:DR VIRKS DENTAL OFFICE
Entity Type:Organization
Organization Name:DR VIRKS DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-233-7777
Mailing Address - Street 1:2108 E EL MONTE WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-9375
Mailing Address - Country:US
Mailing Address - Phone:559-591-7777
Mailing Address - Fax:559-591-7781
Practice Address - Street 1:2108 E EL MONTE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-9375
Practice Address - Country:US
Practice Address - Phone:559-591-7777
Practice Address - Fax:559-591-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty