Provider Demographics
NPI:1811150436
Name:WIRIG, DUSTIN MARK (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:MARK
Last Name:WIRIG
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 UNION ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123
Mailing Address - Country:US
Mailing Address - Phone:415-921-4090
Mailing Address - Fax:415-921-7832
Practice Address - Street 1:2001 UNION ST
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123
Practice Address - Country:US
Practice Address - Phone:415-921-4090
Practice Address - Fax:415-921-7832
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics