Dr. Roger Grannum
Oral and Maxillofacial Surgeon
760 Broadway Oral Surgery Room 2c320
Brooklyn
, New York 11206
Dr. Roger Grannum
Oral and Maxillofacial Surgeon
760 Broadway Oral Surgery Room 2c320
Brooklyn
, New York 11206
(718) 630-3122
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Roger Grannum
- 760 Broadway Oral Surgery Room 2c230
- Brooklyn, NY
- Zip : 11206
- Fax : (718) 630-3122
- Phone : (718) 963-8000
Second Address
- Dr. Roger Grannum
- 760 Broadway Oral Surgery Room 2c320
- Brooklyn, NY
- Zip : 11206
- Fax : (718) 599-4912
- Phone : (718) 963-8000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 50052633 | NY |
National Provider Identifier
| NPI | 1003993502 |
|---|---|
| Provider Name | Dr. Roger Grannum |
| First Address | Brooklyn, NY 11206 |
| Second Address | Brooklyn, NY 11206 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/11/2006 |
| Last Update Date | 06/01/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 03084764 | (05) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.