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General NPI Number Information
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NPI Number | 1629852611
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Entity Type | Individual
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Provider Name | MANDI HIRSCH DDS
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Gender | Female
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 2555 N DIXIE HWY
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City | LAKE WORTH
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State | FL
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Zip | 33460-6250
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Country | US
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Telephone | 561-264-4061
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Fax |
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Provider Business Mailing Address
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Address Line | 20123 NE 19TH PL
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City | MIAMI
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State | FL
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Zip | 33179-1610
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Country | US
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Telephone | 786-303-0703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN25271
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License Number State | FL
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