Provider Demographics
NPI:1033894316
Name:FISCHGRUND DENTAL PLLC
Entity Type:Organization
Organization Name:FISCHGRUND DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAIG
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:FISCHGRUND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-572-9028
Mailing Address - Street 1:372 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3529
Mailing Address - Country:US
Mailing Address - Phone:516-915-1555
Mailing Address - Fax:
Practice Address - Street 1:372 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3529
Practice Address - Country:US
Practice Address - Phone:516-915-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty