Provider Demographics
NPI:1629391370
Name:GRABER ORTHODONTICS P.C.
Entity Type:Organization
Organization Name:GRABER ORTHODONTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-535-7090
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty