Provider Demographics
NPI:1154491959
Name:HIRSCH, GERALD LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
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 1:96 N KENNEDY DR STE 205
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-1674
Mailing Address - Country:US
Mailing Address - Phone:847-426-3402
Mailing Address - Fax:847-426-3473
Practice Address - Street 1:96 N KENNEDY DR STE 205
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-1674
Practice Address - Country:US
Practice Address - Phone:847-426-3402
Practice Address - Fax:847-426-3473
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist