Provider Demographics
NPI:1447365341
Name:VIRK, KANWAL J S (BDS DDS)
Entity type:Individual
Prefix:
First Name:KANWAL
Middle Name:J S
Last Name:VIRK
Suffix:
Gender:M
Credentials:BDS DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 E EL MONTE WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-9375
Mailing Address - Country:US
Mailing Address - Phone:559-591-7777
Mailing Address - Fax:559-591-7777
Practice Address - Street 1:2108 E EL MONTE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-9375
Practice Address - Country:US
Practice Address - Phone:559-591-7777
Practice Address - Fax:559-591-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist