Healthcare Provider Details

I. General information

NPI: 1396928834
Provider Name (Legal Business Name): CRAIG SCOTT PUCHALSKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 S NEW YORK RD SUITE C-1
GALLOWAY NJ
08205-9680
US

IV. Provider business mailing address

48 S NEW YORK RD SUITE C-1
GALLOWAY NJ
08205-9680
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-9171
  • Fax: 609-652-3087
Mailing address:
  • Phone: 609-652-9171
  • Fax: 609-652-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17059
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: