Provider Demographics
NPI:1700143591
Name:FISCHGRUND, GRAIG ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRAIG
Middle Name:ADAM
Last Name:FISCHGRUND
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 1:18 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2222
Mailing Address - Country:US
Mailing Address - Phone:201-572-9028
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:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024983001223P0300X
NY0562651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics