Provider Demographics
NPI:1003083940
Name:WIRIG, MATTHEW RICHARD (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHARD
Last Name:WIRIG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N STEPHANIE ST STE 211
Mailing Address - Street 2:120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8773
Mailing Address - Country:US
Mailing Address - Phone:702-454-1008
Mailing Address - Fax:702-454-1009
Practice Address - Street 1:375 N STEPHANIE ST STE 211
Practice Address - Street 2:120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8773
Practice Address - Country:US
Practice Address - Phone:702-454-1008
Practice Address - Fax:702-454-1009
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55111223G0001X
NVS3-1751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice