Provider Demographics
NPI:1740467646
Name:HUENERGARDT, CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:HUENERGARDT
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 1:4161 OCEANSIDE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6035
Mailing Address - Country:US
Mailing Address - Phone:760-940-2273
Mailing Address - Fax:760-940-4298
Practice Address - Street 1:4161 OCEANSIDE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6035
Practice Address - Country:US
Practice Address - Phone:760-940-2273
Practice Address - Fax:760-940-4298
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist