Provider Demographics
NPI:1568679702
Name:NAVDEEP S. VIRK
Entity Type:Organization
Organization Name:NAVDEEP S. VIRK
Other - Org Name:AVENUE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:509-926-1500
Mailing Address - Street 1:12122 E CATALDO AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6724
Mailing Address - Country:US
Mailing Address - Phone:509-926-1500
Mailing Address - Fax:509-892-0200
Practice Address - Street 1:12122 E CATALDO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6724
Practice Address - Country:US
Practice Address - Phone:509-926-1500
Practice Address - Fax:509-892-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTID