NPIMap

Organization Active NPI

South Center Pediatric Dentistry and Orthodontics LLC

Doing business as South Center Pediatric Dentistry and Orthodontic

  • Pediatric Dentistry
  • Tukwila, WA
National Provider Identifier
1275996191
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
603591381 Issued in WA
Legal business name
SOUTH CENTER PEDIATRIC DENTISTRY AND ORTHODONTICS LLC
Doing business as
South Center Pediatric Dentistry and Orthodontic
Practice address
505 Strander Blvd
Tukwila, WA 98188-2920
Phone
(206) 575-2556
Fax
(253) 604-0598
NPI assigned
Mar 29, 2016
Last updated
Mar 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mahadeep S Virk, DMD
Title
Owner Operator
Phone
(206) 575-2556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 603591381 WA Primary

Addresses

Primary practice location

505 Strander Blvd
Tukwila, WA 98188-2920

Mailing address

505 Strander Blvd
Tukwila, WA 98188-2920
Phone (206) 575-2556

Other identifiers 1

IdentifierTypeStateIssuer
2010685MedicaidWA

Other names 1

  • SOUTH CENTER PEDIATRIC DENTISTRY AND ORTHODONTIC Doing business as

National Provider Directory

National Provider Directory

Locations

505 Strander Blvd
Tukwila, WA 98188
Phone (206) 575-2556

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1275996191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 STRANDER BLVD",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882920",
            "telephone_number": "206-575-2556",
            "fax_number": "253-604-0598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 STRANDER BLVD",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882920",
            "telephone_number": "206-575-2556",
            "fax_number": "253-604-0598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTER PEDIATRIC DENTISTRY AND ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "VIRK",
        "authorized_official_first_name": "MAHADEEP",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER OPERATOR",
        "authorized_official_telephone_number": "206-575-2556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "603591381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010685",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH CENTER PEDIATRIC DENTISTRY AND ORTHODONTIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tukwila, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.