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ROGER GRANNUM DDS, P.C.
NPI 1568600757
Dentist - Oral and Maxillofacial Surgery in Brooklyn, NY

Active since January 27, 2009
730 BROADWAY, BROOKLYN, NY 11206(917) 816-0481 Get Directions Write a Review

NPPES record last updated: September 29, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Roger Grannum Dds, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROGER GRANNUM DDS, P.C. (NPI 1568600757) is a healthcare organization registered as an oral and maxillofacial surgery in Brooklyn, New York and active in the NPI registry since January 2009. The organization lists Roger Grannum, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1568600757
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameROGER GRANNUM DDS, P.C.
Location Address730 BROADWAYBrooklyn, NY 11206-4403
Mailing Address131 Knollwood DrWatchung, NJ 07069-6245 · (917) 816-0481
Phone(917) 816-0481
Organization SubpartNo
Authorized OfficialRoger GrannumChief Executive Officer · (917) 816-0481
Enumeration DateJanuary 27, 2009
Last NPPES UpdateSeptember 29, 2011
✔ NPI 1568600757 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in NY · 052633
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
730 BROADWAY, Brooklyn, NY 11206
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Other Identifiers 2

Medicaid03084764NY
Medicaid0334491NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEVEN L WETTAN D.D.S.
Dentist
730 BROADWAY
BROOKLYN, NY 11206
Kings County (718) 963-1919
DR. HECHT & WETTAN
Dentist (Oral and Maxillofacial Surgery)
730 BROADWAY
BROOKLYN, NY 11206
Kings County (718) 963-1919

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roger Grannum Dds, P.C.'s NPI number?

The NPI number for Roger Grannum Dds, P.C. is 1568600757. It was assigned to this organization in the NPPES registry on January 27, 2009.

Where is Roger Grannum Dds, P.C. located?

Roger Grannum Dds, P.C. is located at 730 Broadway, Brooklyn, NY 11206. The listed phone number is (917) 816-0481.

What is Roger Grannum Dds, P.C.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Roger Grannum Dds, P.C. was last updated on September 29, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.