Provider Demographics
NPI:1497938740
Name:M VIRK DMD & N YOUSSEF DDS
Entity Type:Organization
Organization Name:M VIRK DMD & N YOUSSEF DDS
Other - Org Name:AVENUE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGUIB
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-659-8777
Mailing Address - Street 1:3402 173RD PL NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8497
Mailing Address - Country:US
Mailing Address - Phone:360-659-8777
Mailing Address - Fax:
Practice Address - Street 1:3402 173RD PL NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8497
Practice Address - Country:US
Practice Address - Phone:360-659-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty