Wirth, Kurtis E

Wirth, Kurtis E is an sole proprietor health care provider with primary practice located at 1107 S Mulford Rd , Rockford IL 61108-4212. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Oral and Maxillofacial Surgery. Dental Providers / Dentist is his primary health care specialty. Wirth, Kurtis E can be contacted via phone (815) 965-5233.

Contact Information

Primary practice address
1107 S Mulford Rd Rockford IL 61108-4212
Phone: (815) 965-5233
Fax: (815) 965-9311
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 19016003 Illinois
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 19016003 Illinois

Profile Details

NPI number 1407850761
LBN Legal business name Wirth, Kurtis E
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 1st, 2005
Last updated Jun 22nd, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407850761 NPPES
Illinois MEDICAID 19016003
Illinois MEDICAID 0017598

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