Healthcare Provider Details

I. General information

NPI: 1457528390
Provider Name (Legal Business Name): MATTHEW R. WIRIG, DMD, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N VALLE VERDE DR 120
HENDERSON NV
89074-1774
US

IV. Provider business mailing address

34 N VALLE VERDE DR 120
HENDERSON NV
89074-1774
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-1008
  • Fax:
Mailing address:
  • Phone: 702-454-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-175
License Number StateNV

VIII. Authorized Official

Name: MATTHEW RICHARD WIRIG
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 702-454-1008