Provider Demographics
NPI:1528603503
Name:ELLEN POLSKY DDS AND BOBBY VIRK DMD, PS
Entity Type:Organization
Organization Name:ELLEN POLSKY DDS AND BOBBY VIRK DMD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:XENIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-848-7000
Mailing Address - Street 1:9317 113TH ST E STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3876
Mailing Address - Country:US
Mailing Address - Phone:253-848-7000
Mailing Address - Fax:253-446-6138
Practice Address - Street 1:34704 11TH PL S STE 101
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8730
Practice Address - Country:US
Practice Address - Phone:253-946-5322
Practice Address - Fax:253-446-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty