Provider Demographics
NPI:1689219933
Name:MAHADEEP S VIRK DMD & ELLEN POLSKY DDS, P.L.L.C.
Entity Type:Organization
Organization Name:MAHADEEP S VIRK DMD & ELLEN POLSKY DDS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-726-1800
Mailing Address - Street 1:10317 122ND ST E STE B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2632
Mailing Address - Country:US
Mailing Address - Phone:844-726-1800
Mailing Address - Fax:
Practice Address - Street 1:2702 S 42ND ST STE 106
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7315
Practice Address - Country:US
Practice Address - Phone:844-726-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRK : SKOUNTRIANOS, P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty