Provider Demographics
NPI:1235257437
Name:HERSCH, GEOFFREY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:MARK
Last Name:HERSCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 NEWPORT CENTER DRIVE SUITE 701
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-644-0611
Mailing Address - Fax:949-644-1334
Practice Address - Street 1:400 NEWPORT CENTER DRIVE SUITE 701
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-644-0611
Practice Address - Fax:949-644-1334
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA458741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry