=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588872675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNARD HOWARD KIRSHBAUM DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2506 VIRGINIA AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-965-5400
-----------------------------------------------------
Fax | 202-298-7760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3539 CHESAPEAKE ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20008-2958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-686-0868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------