Provider Demographics
NPI:1447077839
Name:M VIRK & H SKOUNTRIANOS
Entity type:Organization
Organization Name:M VIRK & H SKOUNTRIANOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-848-4537
Mailing Address - Street 1:210 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5863
Mailing Address - Country:US
Mailing Address - Phone:253-848-4538
Mailing Address - Fax:
Practice Address - Street 1:210 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5863
Practice Address - Country:US
Practice Address - Phone:253-848-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty