Provider Demographics
NPI:1962796953
Name:GRANICZ, ANN Z (DMD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:Z
Last Name:GRANICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W BLOOMFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2001
Mailing Address - Country:US
Mailing Address - Phone:812-822-1196
Mailing Address - Fax:
Practice Address - Street 1:1320 W BLOOMFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2001
Practice Address - Country:US
Practice Address - Phone:812-822-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011893A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics