Healthcare Provider Details

I. General information

NPI: 1881840767
Provider Name (Legal Business Name): EDON Y HIRT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 403
BEVERLY HILLS CA
90211-2004
US

IV. Provider business mailing address

111 S POINSETTIA PL
LOS ANGELES CA
90036-2803
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-0444
  • Fax: 310-855-1001
Mailing address:
  • Phone: 310-925-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number51076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: