Provider Demographics
NPI:1235279050
Name:KIRSCH, FREDERIC G (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:G
Last Name:KIRSCH
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 1:1881 N UNIVERSITY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6095
Mailing Address - Country:US
Mailing Address - Phone:954-753-7770
Mailing Address - Fax:
Practice Address - Street 1:1881 N UNIVERSITY DR STE 201
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6095
Practice Address - Country:US
Practice Address - Phone:954-753-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN60271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry