Provider Demographics
NPI:1912299140
Name:JACK J. HIRSCHFELD DDS PA
Entity Type:Organization
Organization Name:JACK J. HIRSCHFELD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIRSCHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-642-1202
Mailing Address - Street 1:2459 S CONGRESS AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7616
Mailing Address - Country:US
Mailing Address - Phone:561-642-1202
Mailing Address - Fax:561-642-7602
Practice Address - Street 1:2459 S CONGRESS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7616
Practice Address - Country:US
Practice Address - Phone:561-642-1202
Practice Address - Fax:561-642-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN94461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty