Healthcare Provider Details

I. General information

NPI: 1811150436
Provider Name (Legal Business Name): DUSTIN MARK WIRIG DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 UNION ST SUITE 280
SAN FRANCISCO CA
94123
US

IV. Provider business mailing address

2001 UNION ST SUITE 280
SAN FRANCISCO CA
94123
US

V. Phone/Fax

Practice location:
  • Phone: 415-921-4090
  • Fax: 415-921-7832
Mailing address:
  • Phone: 415-921-4090
  • Fax: 415-921-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number57129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: