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General NPI Number Information
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NPI Number | 1689829913
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Entity Type | Organization
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Legal Business Name | IRVING M BLAU DDS & RICHARD A KIRSCH DDS PC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 24415 W WARREN ST
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City | DEARBORN HTS
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State | MI
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Zip | 48127-2223
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Country | US
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Telephone | 313-278-4470
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Fax | 313-278-0124
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Provider Business Mailing Address
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Address Line | 24415 W WARREN ST
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City | DEARBORN HTS
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State | MI
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Zip | 48127-2223
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Country | US
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Telephone | 313-278-4470
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Fax | 313-278-0124
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Authorized Official
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Title or Position | PARTNER
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Name | DR. IRVING M BLAU
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Credential | DDS
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Telephone | 313-278-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9971
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12216
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License Number State | MI
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