Provider Demographics
NPI:1073595534
Name:HIRSCH, LAWRENCE MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARTIN
Last Name:HIRSCH
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 1:33 HARTSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2208
Mailing Address - Country:US
Mailing Address - Phone:718-459-0872
Mailing Address - Fax:718-228-6031
Practice Address - Street 1:8504 63RD DR
Practice Address - Street 2:#3L
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4845
Practice Address - Country:US
Practice Address - Phone:718-459-0872
Practice Address - Fax:718-228-6031
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist