Provider Demographics
NPI:1306944186
Name:HIRSCH, HAL M (DMD, FAGD)
Entity type:Individual
Prefix:
First Name:HAL
Middle Name:M
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CHEWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2702
Mailing Address - Country:US
Mailing Address - Phone:856-227-4200
Mailing Address - Fax:856-227-3231
Practice Address - Street 1:1350 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2702
Practice Address - Country:US
Practice Address - Phone:856-227-4200
Practice Address - Fax:856-227-3231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 158121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA501454OtherID FOR UNITED CONCORDIA