Provider Demographics
NPI:1194995225
Name:GRAZINA, VICTOR JR (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JR
Last Name:GRAZINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:JOSEPH
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87 NEWTOWN LN
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2485
Mailing Address - Country:US
Mailing Address - Phone:631-604-2206
Mailing Address - Fax:
Practice Address - Street 1:87 NEWTOWN LN
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2485
Practice Address - Country:US
Practice Address - Phone:631-604-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics