Provider Demographics
NPI:1801811575
Name:WIRANT, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WIRANT
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 1:59 ALDRICH RD
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NH
Mailing Address - Zip Code:03467-4700
Mailing Address - Country:US
Mailing Address - Phone:603-399-4491
Mailing Address - Fax:
Practice Address - Street 1:650 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1799
Practice Address - Country:US
Practice Address - Phone:603-352-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice