Provider Demographics
NPI:1477654077
Name:FINE, CRAIG IRVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:IRVIN
Last Name:FINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3707
Mailing Address - Country:US
Mailing Address - Phone:973-830-0814
Mailing Address - Fax:
Practice Address - Street 1:240 E PALISADE AVE
Practice Address - Street 2:SUITE 11-C
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3169
Practice Address - Country:US
Practice Address - Phone:201-569-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023185001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice