Provider Demographics
NPI:1417967704
Name:KIRSCH, MICHAEL GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GREGORY
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 1:4660 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2063
Mailing Address - Country:US
Mailing Address - Phone:863-382-8878
Mailing Address - Fax:863-382-8021
Practice Address - Street 1:4660 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2063
Practice Address - Country:US
Practice Address - Phone:863-382-8878
Practice Address - Fax:863-382-8021
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics