Provider Demographics
NPI:1295851673
Name:WIRTSCHAFTER DENTAL CORPORATION
Entity Type:Organization
Organization Name:WIRTSCHAFTER DENTAL CORPORATION
Other - Org Name:STUDIO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRTSCHAFTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-839-8033
Mailing Address - Street 1:3855 HUGHES AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2729
Mailing Address - Country:US
Mailing Address - Phone:310-839-8033
Mailing Address - Fax:310-839-8035
Practice Address - Street 1:3855 HUGHES AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2729
Practice Address - Country:US
Practice Address - Phone:310-839-8033
Practice Address - Fax:310-839-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty