Organization
NORTH TACOMA PEDIATRIC DENTISTRY AND ORTHODONTICS LLC
Active
Other names
NORTH TACOMA PEDIATRIC DENTISTRY AND ORTHODONTICS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHADEEP S VIRK DMD (OWNER OPERATOR)
(253) 627-5027
Entity
Organization
Contact information
Practice address
3402 S 18TH ST, SUITE B, TACOMA, WA 98405-1903
(253) 627-5027
(253) 383-7747
Mailing address
3402 S 18TH ST, SUITE B, TACOMA, WA 98405-1903
(253) 627-5027
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
603591384
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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