Provider Demographics
NPI:1912082868
Name:KIRSH, EDWARD RONALD (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:RONALD
Last Name:KIRSH
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 1:3 S.W. 129 AVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1779
Mailing Address - Country:US
Mailing Address - Phone:954-438-4282
Mailing Address - Fax:954-442-6511
Practice Address - Street 1:3 SW 129TH AVE
Practice Address - Street 2:STE 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-438-4282
Practice Address - Fax:954-442-6511
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010576412OtherERS