Healthcare Provider Details

I. General information

NPI: 1962920801
Provider Name (Legal Business Name): COLIN THOMAS HIRSCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16579 PEAK WAY
BROOMFIELD CO
80023-6708
US

IV. Provider business mailing address

16579 PEAK WAY
BROOMFIELD CO
80023-6708
US

V. Phone/Fax

Practice location:
  • Phone: 630-677-7501
  • Fax:
Mailing address:
  • Phone: 720-295-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00205312
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: