Provider Demographics
NPI:1780724849
Name:KIRSCHBAUM, RICHARD STEWART (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEWART
Last Name:KIRSCHBAUM
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 1:147 SILKEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1420
Mailing Address - Country:US
Mailing Address - Phone:860-653-3428
Mailing Address - Fax:
Practice Address - Street 1:26 EAST GRANBY RD.
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-0450
Practice Address - Country:US
Practice Address - Phone:860-653-7596
Practice Address - Fax:860-653-9536
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice