Healthcare Provider Details

I. General information

NPI: 1134425507
Provider Name (Legal Business Name): MATTHEW R WIRIG, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 MEADOWS LN STE A
LAS VEGAS NV
89107-2965
US

IV. Provider business mailing address

4610 MEADOWS LN STE A
LAS VEGAS NV
89107-2965
US

V. Phone/Fax

Practice location:
  • Phone: 702-482-8299
  • Fax: 702-822-1345
Mailing address:
  • Phone: 702-482-8299
  • Fax: 702-822-1345

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: DR. MATTHEW WIRIG
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 702-482-8299