Provider Demographics
NPI:1386605152
Name:HIRSCH, STANLEY A (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:HIRSCH
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 1:30701 LORAIN RD
Mailing Address - Street 2:STE A
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6325
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:6365 LONGRIDGE RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4114
Practice Address - Country:US
Practice Address - Phone:440-646-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0140941223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000115378OtherANTHEM
WY11649450001Medicaid
OH1100582OtherUNITED HEALTHCARE
OH000000115378OtherANTHEM
WY11649450001Medicaid
OH1100582OtherUNITED HEALTHCARE