Provider Demographics
NPI:1528152568
Name:GRANGER, ALBERT L (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:GRANGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1103 STEWART AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4886
Mailing Address - Country:US
Mailing Address - Phone:516-222-1822
Mailing Address - Fax:516-227-5361
Practice Address - Street 1:1103 STEWART AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4886
Practice Address - Country:US
Practice Address - Phone:516-222-1822
Practice Address - Fax:516-227-5361
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY04106711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics