Provider Demographics
NPI:1982711073
Name:KIRSCH, KENNETH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
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 1:919 ABBOTSFORD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9707
Mailing Address - Country:US
Mailing Address - Phone:815-469-3744
Mailing Address - Fax:708-301-8515
Practice Address - Street 1:15801 S BELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7648
Practice Address - Country:US
Practice Address - Phone:708-301-9401
Practice Address - Fax:708-301-8515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice