Roger Grannum DDS, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

052633 Issued in NY

Legal business name

ROGER GRANNUM DDS, P.C.

Practice address

730 Broadway
Brooklyn, NY 11206-4403

Phone

(917) 816-0481

NPI assigned

Jan 27, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Roger Grannum, DDS

Title

Chief Executive Officer

Phone

(917) 816-0481

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven R Izzo, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Ridgewood, NY
  • NPI 1750379699
  NPD (past)
• Steven L Wettan, D.D.S.

  • Dentist
  • Brooklyn, NY
  • NPI 1588646855
  NPD (past)

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1568600757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 KNOLLWOOD DR",
            "city": "WATCHUNG",
            "state": "NJ",
            "postal_code": "070696245",
            "telephone_number": "917-816-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 BROADWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112064403",
            "telephone_number": "917-816-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER GRANNUM DDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-27",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "GRANNUM",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "917-816-0481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "052633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03084764",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0334491",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mashhura Rofieva
• Iwona Weronika Rogalski, PTA,
• Curtis Rogalsky
• Laura Lee Rogalsky, LMSW
• Tanya Yehudith Rogalsky, RN
• Roger Kennedy Boyce MD
• Jenny Roger
• Elida Rogers-Reyes
• Camille Rogers
• Emily Rogers, LCSW

• 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 Sep 29, 2011; 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.