Provider Demographics
NPI:1891147229
Name:VIRK, CHARANDEEP KAUR
Entity Type:Individual
Prefix:DR
First Name:CHARANDEEP
Middle Name:KAUR
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 1:53 ROCHELA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4670
Mailing Address - Country:US
Mailing Address - Phone:917-848-7311
Mailing Address - Fax:
Practice Address - Street 1:53 ROCHELA DR
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4670
Practice Address - Country:US
Practice Address - Phone:917-848-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist