Provider Demographics
NPI:1003948555
Name:HIRSCH, MARTIN ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ALAN
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1578 HAZEL LN
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1313
Mailing Address - Country:US
Mailing Address - Phone:847-446-9696
Mailing Address - Fax:847-446-3404
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-248-6140
Practice Address - Fax:773-248-4628
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190155761223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics