Provider Demographics
NPI:1093856825
Name:KIRSCHBAUM, EILEEN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:C
Last Name:KIRSCHBAUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230A MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078
Mailing Address - Country:US
Mailing Address - Phone:860-668-6128
Mailing Address - Fax:860-386-6736
Practice Address - Street 1:230A MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078
Practice Address - Country:US
Practice Address - Phone:860-668-6128
Practice Address - Fax:860-386-6736
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry