Provider Demographics
NPI:1629055017
Name:BARRY J AGRANAT DMP PC
Entity Type:Organization
Organization Name:BARRY J AGRANAT DMP PC
Other - Org Name:DR BARRY J AGRANAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGRANAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-924-0910
Mailing Address - Street 1:106 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3931
Mailing Address - Country:US
Mailing Address - Phone:617-924-0910
Mailing Address - Fax:617-926-6739
Practice Address - Street 1:106 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3931
Practice Address - Country:US
Practice Address - Phone:617-924-0910
Practice Address - Fax:617-926-6739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARRY J AGRANAT DMP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16166OtherHARVARD PILGRIM HEALTH
MAX10650OtherBLUE CROSS SHIELD