Provider Demographics
NPI:1740320555
Name:HIRSCHBERG, CRAIG STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STANLEY
Last Name:HIRSCHBERG
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 1:365 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1632
Mailing Address - Country:US
Mailing Address - Phone:973-763-8175
Mailing Address - Fax:
Practice Address - Street 1:1173 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3132
Practice Address - Country:US
Practice Address - Phone:201-339-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI1030971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics