Provider Demographics
NPI:1154537280
Name:MAHADEEP VIRK, DMD-BREMERTON PS
Entity type:Organization
Organization Name:MAHADEEP VIRK, DMD-BREMERTON PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHADEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-792-0300
Mailing Address - Street 1:2741 WHEATON WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3344
Mailing Address - Country:US
Mailing Address - Phone:360-792-0300
Mailing Address - Fax:360-792-0302
Practice Address - Street 1:2741 WHEATON WAY
Practice Address - Street 2:SUITE B
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3344
Practice Address - Country:US
Practice Address - Phone:360-792-0300
Practice Address - Fax:360-792-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty