Provider Demographics
NPI:1578644100
Name:MAHADEEP VIRK DMD EVERETT, PS
Entity Type:Organization
Organization Name:MAHADEEP VIRK DMD EVERETT, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-438-8584
Mailing Address - Street 1:8625 EVERGREEN WAY 212
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-438-8584
Mailing Address - Fax:425-438-2625
Practice Address - Street 1:8625 EVERGREEN WAY 212
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-438-8584
Practice Address - Fax:425-438-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA81441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty