Provider Demographics
NPI:1255978763
Name:VIRK TMJ PLLC
Entity type:Organization
Organization Name:VIRK TMJ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMRITTEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-251-9985
Mailing Address - Street 1:630 N KIMBALL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6887
Mailing Address - Country:US
Mailing Address - Phone:817-251-9985
Mailing Address - Fax:
Practice Address - Street 1:630 N KIMBALL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6887
Practice Address - Country:US
Practice Address - Phone:817-251-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental