Organization
SOUTH CENTER PEDIATRIC DENTISTRY AND ORTHODONTICS LLC
Active
Other names
SOUTH CENTER PEDIATRIC DENTISTRY AND ORTHODONTIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHADEEP S VIRK DMD (OWNER OPERATOR)
(206) 575-2556
Entity
Organization
Contact information
Practice address
505 STRANDER BLVD, TUKWILA, WA 98188-2920
(206) 575-2556
(253) 604-0598
Mailing address
505 STRANDER BLVD, TUKWILA, WA 98188-2920
(206) 575-2556
(253) 604-0598
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
603591381
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010685
—
WA
Enumeration date
03/29/2016
Last updated
03/29/2016
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