Provider Demographics
NPI:1053317842
Name:HIRSCHFELD, JACK JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:JACOB
Last Name:HIRSCHFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 S CONGRESS AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7616
Mailing Address - Country:US
Mailing Address - Phone:561-642-1202
Mailing Address - Fax:561-642-7602
Practice Address - Street 1:2459 S CONGRESS AVE
Practice Address - Street 2:STE 206
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7616
Practice Address - Country:US
Practice Address - Phone:561-642-1202
Practice Address - Fax:561-642-7602
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN94461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54868FLMedicare UPIN