Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 60885 | CA |
NPI | 1043767866 |
---|---|
Provider Name | Dr. Dan Grauer |
First Address | Santa Monica, CA 90401-2693 |
Second Address | Santa Monica, CA 90401-2693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 09/09/2016 |