Provider Demographics
NPI:1053701078
Name:STEPHANIE HIRT DMD LLC
Entity type:Organization
Organization Name:STEPHANIE HIRT DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HIRT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-547-0520
Mailing Address - Street 1:607 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1906
Mailing Address - Country:US
Mailing Address - Phone:856-547-0520
Mailing Address - Fax:
Practice Address - Street 1:607 STATION AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1906
Practice Address - Country:US
Practice Address - Phone:856-547-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022778-00261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental