Provider Demographics
NPI:1346388592
Name:GRANGER, JOHN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:GRANGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 RT 55
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540
Mailing Address - Country:US
Mailing Address - Phone:845-452-4031
Mailing Address - Fax:845-486-4174
Practice Address - Street 1:1133 RT 55
Practice Address - Street 2:SUITE C
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540
Practice Address - Country:US
Practice Address - Phone:845-452-4031
Practice Address - Fax:845-486-4174
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist