Provider Demographics
NPI:1467775114
Name:GRABER, MORDECHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MORDECHAI
Middle Name:
Last Name:GRABER
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 1:2635 NOSTRAND AVE
Mailing Address - Street 2:SUITE L2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4641
Mailing Address - Country:US
Mailing Address - Phone:718-535-7090
Mailing Address - Fax:718-535-7033
Practice Address - Street 1:2635 NOSTRAND AVE
Practice Address - Street 2:SUITE L2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4641
Practice Address - Country:US
Practice Address - Phone:718-535-7090
Practice Address - Fax:718-535-7033
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics