Provider Demographics
NPI:1790266815
Name:KIRSCH, CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
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 1:23378 LOWRIE DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1508
Mailing Address - Country:US
Mailing Address - Phone:734-377-4821
Mailing Address - Fax:
Practice Address - Street 1:5198 N NEVADA AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8649
Practice Address - Country:US
Practice Address - Phone:719-634-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002037761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice