DR. ROGER GRANNUM DDS NPI 1003993502

NPI Information

NPI: 1003993502
Provider Name: DR. ROGER GRANNUM, DDS
Classification: Dentist - 1223S0112X
Specialization: Oral and Maxillofacial Surgery
Entity Type: Individual
Address: 760 BROADWAY
ORAL SURGERY ROOM 2C320
BROOKLYN, NY
ZIP 11206
Phone: (718) 963-8000

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NPI Details

DR. Roger Grannum, DDS is an oral and maxillofacial surgery dentist in Brooklyn, NY. The provider is 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. DR. Roger Grannum, DDS NPI is 1003993502. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

760 BROADWAY
ORAL SURGERY ROOM 2C320
BROOKLYN, NY
ZIP 11206
Phone: (718) 963-8000
Fax: (718) 599-4912

The enumeration date for this NPI number is 11/1/2006 and was last updated on 1/6/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223S0112X	Dentist	Oral and Maxillofacial Surgery	50052633	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03084764	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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