Provider Demographics
NPI:1467628719
Name:BIRSCH, FREDERICK THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:THOMAS
Last Name:BIRSCH
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 1:3413 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3219
Mailing Address - Country:US
Mailing Address - Phone:757-393-9929
Mailing Address - Fax:757-393-6353
Practice Address - Street 1:3413 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3219
Practice Address - Country:US
Practice Address - Phone:757-393-9929
Practice Address - Fax:757-393-6353
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice