Provider Demographics
NPI:1013080357
Name:EDWARD J. KIRSCH, D.D.S., P.C.
Entity Type:Organization
Organization Name:EDWARD J. KIRSCH, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-469-3373
Mailing Address - Street 1:590 BANKVIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1382
Mailing Address - Country:US
Mailing Address - Phone:815-469-3373
Mailing Address - Fax:815-469-0313
Practice Address - Street 1:590 BANKVIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1382
Practice Address - Country:US
Practice Address - Phone:815-469-3373
Practice Address - Fax:815-469-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190203441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty