MEDICARE: KIRSCH & BLAU DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1003260340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRSCH & BLAU DDS PC

Provider Business Mailing Address
First Line	:	24415 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2223
Country	:	US
Telephone Number	:	313-278-4470
Fax Number	:

Provider Business Practice Location Address
First Line	:	24415 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2223
Country	:	US
Telephone Number	:	313-278-4470
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD KIRSCH
Credential	:	DDS
Telephone Number	:	313-278-4470

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/22/2016

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