Individual
DR. ROGER GRANNUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
760 BROADWAY, ORAL SURGERY ROOM 2C320, BROOKLYN, NY 11206
(718) 963-8000
(718) 599-4912
Mailing address
760 BROADWAY, ORAL SURGERY ROOM 2C230, BROOKLYN, NY 11206
(718) 963-8000
(718) 630-3122
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
50052633
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03084764
—
NY
Enumeration date
11/01/2006
Last updated
01/06/2017
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