Individual
DR. KURTIS E WIRTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1107 S MULFORD RD, ROCKFORD, IL 61108-4212
(815) 965-5233
(815) 965-9311
Mailing address
1107 S MULFORD RD, ROCKFORD, IL 61108-4212
(815) 965-5233
(815) 965-9311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19016003
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
19016003
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017598
—
WI
05
—
19016003
—
IL
Enumeration date
06/01/2005
Last updated
06/22/2016
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