Roger Wirtz DMD PA

Primary specialty

DentistTaxonomy code 122300000X

License

204083 Issued in MS

Legal business name

ROGER WIRTZ DMD PA

Practice address

1765 Lelia Drive
Jackson, MS 39216-4820

Phone

(601) 982-5349

Fax

(601) 982-9084

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Roger Stephenson Wirtz, DMDNPI 1639318116

Title

President

Phone

(601) 982-5349

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roger Stephenson Wirtz, D.M.D.

  • General Practice Dentistry
  • Jackson, MS
  • NPI 1639318116
  NPD (past) Authorized official

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861564817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 LELIA DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164820",
            "telephone_number": "601-982-5349",
            "fax_number": "601-982-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 LELIA DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164820",
            "telephone_number": "601-982-5349",
            "fax_number": "601-982-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER WIRTZ DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIRTZ",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "STEPHENSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-982-5349",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "204083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sommer L Rodrigue, SPEECH PATHOLOGIST
• Gloria Cecilia Rodriguez, M.D.
• Vanessa Andrea Rodriguez, RRT
• Richard Taylor Roe, LCSW
• Brittany Rogel, RDH
• Aeryn Elise Rogers, DO
• James Lee Rogers II, LPC
• Katherine Rogers, PA-C
• Lindsay E Rogers, PHARM.D.
• Seth Bradford Rogers, PA-C

• Dentist in Jackson, MS
• Providers in Jackson, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.