Provider Demographics
NPI:1053412239
Name:SPRUNG, CRAIG MITCHELL (DMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MITCHELL
Last Name:SPRUNG
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 1:108 MAIN ST
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1030
Mailing Address - Country:US
Mailing Address - Phone:732-544-0999
Mailing Address - Fax:732-542-2101
Practice Address - Street 1:108 MAIN ST
Practice Address - Street 2:SUITE 2L
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1030
Practice Address - Country:US
Practice Address - Phone:732-544-0999
Practice Address - Fax:732-542-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012592001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice