Individual
DR. ROGER STEPHENSON WIRTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1765 LELIA DR., JACKSON, MS 39216-4820
(601) 982-5349
(601) 982-9084
Mailing address
1765 LELIA DRIVE, JACKSON, MS 39216-4820
(601) 982-5349
(601) 982-9084
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2040-83
MS
Other
Enumeration date
02/06/2009
Last updated
02/06/2009
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