Healthcare Provider Details

I. General information

NPI: 1598745531
Provider Name (Legal Business Name): GEORGE FLUGRAD D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 AMBOY AVE
WOODBRIDGE NJ
07095-2960
US

IV. Provider business mailing address

453 AMBOY AVE
WOODBRIDGE NJ
07095-2960
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-1860
  • Fax: 732-874-5198
Mailing address:
  • Phone: 732-442-1860
  • Fax: 732-874-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12795
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: