Douglas Lee Wirth, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00005773 Issued in WA

Practice address

275 SE Cabot Dr
Suite B-201
Oak Harbor, WA 98277-3715

Phone

(360) 675-6404

Fax

(360) 240-1301

NPI assigned

Oct 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1053493783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR",
            "address_2": "SUITE B-201",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773715",
            "telephone_number": "360-675-6404",
            "fax_number": "360-240-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR",
            "address_2": "SUITE B-201",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773715",
            "telephone_number": "360-675-6404",
            "fax_number": "360-240-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTH",
        "first_name": "DOUGLAS",
        "middle_name": "LEE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00005773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikayla Willis
• Allyson Noelle Willson
• Carly N Wilson
• Nellie Wilson, LMT, LMP
• Derek Thomas Wirth, DMD
• Jared M Wirth, DMD
• Frank Gino Wolfe
• Terrence C. Wong, MD
• Darin Jeffrey Worley
• Traci Worthley

• General Practice Dentistry in Oak Harbor, WA
• Providers in Oak Harbor, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.