# MAHADEEP VIRK, DMD-PUYALLUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Avenue Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013123181
- **Authorized official:** DR. MAHADEEP S VIRK DMD (PRESIDENT)
- **Authorized official phone:** (253) 435-5656

## Contact information

- **Practice address:** 10317 122ND ST E, SUITE D, PUYALLUP, WA 98374-2632
- **Practice address phone:** (253) 435-5656
- **Practice address fax:** (253) 435-5838
- **Mailing address:** 10317 122ND ST E, SUITE D, PUYALLUP, WA 98374-2632
- **Mailing address phone:** (253) 435-5656
- **Mailing address fax:** (253) 435-5838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 12/21/2010