Organization
ROGER WIRTZ DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER STEPHENSON WIRTZ DMD (PRESIDENT)
(601) 982-5349
Entity
Organization
Contact information
Practice address
1765 LELIA DRIVE, 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
122300000X
Dentist
Primary
204083
MS
Other
Enumeration date
11/14/2006
Last updated
08/22/2020
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