Organization
ROGER GRANNUM DDS, P.C.
Active
Organization
ROGER GRANNUM DDS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER GRANNUM DDS (CHIEF EXECUTIVE OFFICER)
(917) 816-0481
Entity
Organization
Contact information
Practice address
730 BROADWAY, BROOKLYN, NY 11206-4403
(917) 816-0481
Mailing address
131 KNOLLWOOD DR, WATCHUNG, NJ 07069-6245
(917) 816-0481
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
052633
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03084764
—
NY
05
—
0334491
—
NY
Enumeration date
01/27/2009
Last updated
09/29/2011
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