MEDICARE: MATTHEW R WIRIG, DMD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-175	NV

General Provider Information

NPI Number	:	1134425507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW R WIRIG, DMD, PC

Provider Business Mailing Address
First Line	:	4610 MEADOWS LN STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2965
Country	:	US
Telephone Number	:	702-482-8299
Fax Number	:	702-822-1345

Provider Business Practice Location Address
First Line	:	4610 MEADOWS LN STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2965
Country	:	US
Telephone Number	:	702-482-8299
Fax Number	:	702-822-1345

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. MATTHEW WIRIG
Credential	:	DMD
Telephone Number	:	702-482-8299

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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