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:
Health care specialties
| Specialty | Code | License # | 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 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407850761 | NPPES |
| Illinois | MEDICAID | 19016003 | |
| Illinois | MEDICAID | 0017598 |
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