Provider Demographics
NPI:1326388265
Name:GRANGER, BEVERLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2616
Mailing Address - Country:US
Mailing Address - Phone:516-676-4610
Mailing Address - Fax:516-676-5253
Practice Address - Street 1:90 WALNUT RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2616
Practice Address - Country:US
Practice Address - Phone:516-676-4610
Practice Address - Fax:516-676-5253
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice