Provider Demographics
NPI:1265437131
Name:HIRSCH, THOMAS R (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23440 CIVIC CENTER WAY
Mailing Address - Street 2:STE 206
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5907
Mailing Address - Country:US
Mailing Address - Phone:310-456-3363
Mailing Address - Fax:
Practice Address - Street 1:23440 CIVIC CENTER WAY
Practice Address - Street 2:STE 206
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5907
Practice Address - Country:US
Practice Address - Phone:310-456-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice