MEDICARE: DR. STEPHANIE LYNN HIRT DMD

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	1223G0001X	General Practice Dentistry	DS036803	PA
2	1223G0001X	General Practice Dentistry	BH9474254	NJ

General Provider Information

NPI Number	:	1467543702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LYNN HIRT DMD

Provider Business Mailing Address
First Line	:	216 HADDON AVE
Second Line	:	SUITE 109
City	:	HADDON TWP
State	:	NJ
Zip	:	08108
Country	:	US
Telephone Number	:	856-888-4478
Fax Number	:	856-983-3356

Provider Business Practice Location Address
First Line	:	216 HADDON AVE
Second Line	:	SUITE 109
City	:	HADDON TWP
State	:	NJ
Zip	:	08108
Country	:	US
Telephone Number	:	856-888-4478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/25/2022

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