# PARK AVENUE DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558733196
- **Authorized official:** DR. BRUCE HIRSHORN DMD (ORAL SURGEON)
- **Authorized official phone:** (201) 864-4730

## Contact information

- **Practice address:** 3508 PARK AVE, WEEHAWKEN, NJ 07086-6006
- **Practice address phone:** (201) 864-4730
- **Practice address fax:** (201) 864-4734
- **Mailing address:** 3508 PARK AVE, WEEHAWKEN, NJ 07086-6006
- **Mailing address phone:** (201) 864-4730
- **Mailing address fax:** (201) 864-4734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI01527800 | NJ | Yes |

## Other

- **Enumeration date:** 10/22/2015
- **Last updated:** 10/22/2015