| Roger Grannum Dds, P.c. | |
|
730 Broadway Brooklyn NY 11206-4403 | |
| (917) 816-0481 | |
| Not Available |
| Full Name | Roger Grannum Dds, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 730 Broadway, Brooklyn, New York |
| Authorized Official Name and Position | Roger Grannum (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9178160481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger Grannum Dds, P.c. 131 Knollwood Dr Watchung NJ 07069-6245 Ph: (917) 816-0481 | Roger Grannum Dds, P.c. 730 Broadway Brooklyn NY 11206-4403 Ph: (917) 816-0481 |
| NPI Number | 1568600757 |
|---|---|
| Provider Enumeration Date | 01/27/2009 |
| Last Update Date | 09/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568600757 | NPI | - | NPPES |
| 03084764 | Medicaid | NY | |
| 0334491 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 052633 (New York) | Primary |
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