Healthcare Provider Details

I. General information

NPI: 1386605152
Provider Name (Legal Business Name): STANLEY A HIRSCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6365 LONGRIDGE RD
MAYFIELD HEIGHTS OH
44124-4114
US

IV. Provider business mailing address

30701 LORAIN RD STE A
NORTH OLMSTED OH
44070-6325
US

V. Phone/Fax

Practice location:
  • Phone: 440-646-2552
  • Fax:
Mailing address:
  • Phone: 440-274-5000
  • Fax: 440-716-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30-014094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: