Provider Demographics
NPI:1780833202
Name:VIRK, GEETIKA
Entity Type:Individual
Prefix:DR
First Name:GEETIKA
Middle Name:
Last Name:VIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28791 CALLE POSADA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5500
Mailing Address - Country:US
Mailing Address - Phone:949-614-9086
Mailing Address - Fax:
Practice Address - Street 1:28791 CALLE POSADA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-5500
Practice Address - Country:US
Practice Address - Phone:949-614-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist