Provider Demographics
NPI:1043767866
Name:GRAUER, DAN (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:GRAUER
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 7TH ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2693
Mailing Address - Country:US
Mailing Address - Phone:310-401-2929
Mailing Address - Fax:
Practice Address - Street 1:1418 7TH ST
Practice Address - Street 2:UNIT 102
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2693
Practice Address - Country:US
Practice Address - Phone:310-401-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics