Provider Demographics
NPI:1073607776
Name:HIRSCH, JEFFREY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10256 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6182
Mailing Address - Country:US
Mailing Address - Phone:425-453-0236
Mailing Address - Fax:
Practice Address - Street 1:11105 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6319
Practice Address - Country:US
Practice Address - Phone:425-462-0756
Practice Address - Fax:425-688-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00542OtherWASHINGTON DENTAL SERVICE
WA625617OtherUNITED CONCORDIA NUMBER
WA60167-1OtherDENTAL BENEFITS NUMBER
WAH19298OtherREGENCE NUMBER