Provider Demographics
NPI:1356501639
Name:WIRTH, STEVEN GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GEORGE
Last Name:WIRTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 S 86TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-617-0887
Mailing Address - Fax:402-483-4736
Practice Address - Street 1:4444 S 86TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-617-0887
Practice Address - Fax:402-483-4736
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9093122300000X
NE6976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist