Individual
CORY ALAN WIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
125 N EXECUTIVE DR STE 105, BROOKFIELD, WI 53005-6035
(262) 444-0232
Mailing address
W225N2821 FOXWOOD CT, WAUKESHA, WI 53186-8855
(563) 219-6650
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6001013-15
WI
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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