Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 5511 | NV |
N | 213EG0000X | General Practice | 5511 | NV |
Y | 1223X0400X | Orthodontists | S3-175 | NV |
NPI | 1003083940 |
---|---|
Provider Name | Matthew Richard Wirig |
First Address | Henderson, NV 89014-8773 |
Second Address | Henderson, NV 89014-8773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 20/04/2017 |