Provider Demographics
NPI:1346789047
Name:DAVID M KIRSCHNER DDS PC
Entity Type:Organization
Organization Name:DAVID M KIRSCHNER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIRSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-354-3500
Mailing Address - Street 1:29425 NORTHWESTERN HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1000
Mailing Address - Country:US
Mailing Address - Phone:248-354-3500
Mailing Address - Fax:
Practice Address - Street 1:29425 NORTHWESTERN HWY STE 310
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1000
Practice Address - Country:US
Practice Address - Phone:248-354-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010138741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI121772782Medicaid