Provider Demographics
NPI:1780121673
Name:COVINGTON ORTHODONTICS AND PEDIATRIC DENTISTRY L.L.C.
Entity type:Organization
Organization Name:COVINGTON ORTHODONTICS AND PEDIATRIC DENTISTRY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-786-5351
Mailing Address - Street 1:17121 SE 270TH PL
Mailing Address - Street 2:STE 102
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5431
Mailing Address - Country:US
Mailing Address - Phone:253-533-2999
Mailing Address - Fax:
Practice Address - Street 1:17121 SE 270TH PL
Practice Address - Street 2:STE 102
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5431
Practice Address - Country:US
Practice Address - Phone:253-533-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty