Provider Demographics
NPI:1407038623
Name:HIRSCH, EDNA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:E
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GLENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1413
Mailing Address - Country:US
Mailing Address - Phone:410-836-2164
Mailing Address - Fax:
Practice Address - Street 1:516 GLENVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1413
Practice Address - Country:US
Practice Address - Phone:410-836-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist