Provider Demographics
NPI:1699590174
Name:MAHADEEP VIRK DMD, MSD & ELLEN POLSKY DDS
Entity type:Organization
Organization Name:MAHADEEP VIRK DMD, MSD & ELLEN POLSKY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-219-5730
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-0047
Mailing Address - Country:US
Mailing Address - Phone:253-848-4000
Mailing Address - Fax:253-604-4130
Practice Address - Street 1:22530 SE 64TH PL STE 130
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5353
Practice Address - Country:US
Practice Address - Phone:253-848-4000
Practice Address - Fax:253-604-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty