Roger Grannum, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

50052633 Issued in NY

Practice address

760 Broadway
Oral Surgery Room 2C320
Brooklyn, NY 11206

Phone

(718) 963-8000

Fax

(718) 599-4912

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: rgrannum562280@nychhc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Hecht & Wettan

  • Oral and Maxillofacial Surgery (Dentist)
  • Brooklyn, NY
  • NPI 1982870879
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1003993502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 BROADWAY",
            "address_2": "ORAL SURGERY ROOM 2C230",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11206",
            "telephone_number": "718-963-8000",
            "fax_number": "718-630-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 BROADWAY",
            "address_2": "ORAL SURGERY ROOM 2C320",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11206",
            "telephone_number": "718-963-8000",
            "fax_number": "718-599-4912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANNUM",
        "first_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "50052633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03084764",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Marie Granice, LMSW
• Tanya D Granick, MA
• Meghan Cass Graniello, LCSW
• Tatyana Granik, PHARM D.
• Charles Frederick Grannum, MD
• Granny Homecare LLC (Granny Homecare)
• Dean Yehoshua Granot
• Graig V Granovsky, DC
• Megan Granski, PHD
• Michelle Amanda Grant McKinney

• Oral and Maxillofacial Surgery (Dentist) in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.