Provider Demographics
NPI:1356462618
Name:GRANGER, TOD REED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:REED
Last Name:GRANGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NOYAC ROAD
Mailing Address - Street 2:BLDG B
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963
Mailing Address - Country:US
Mailing Address - Phone:631-725-4341
Mailing Address - Fax:631-725-6410
Practice Address - Street 1:3330 NOYAC ROAD
Practice Address - Street 2:BLDG B
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963
Practice Address - Country:US
Practice Address - Phone:631-725-4341
Practice Address - Fax:631-725-6410
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03493811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics