Provider Demographics
NPI:1972661320
Name:GRANGER, DANIEL EARLE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EARLE
Last Name:GRANGER
Suffix:
Gender:M
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:PO BOX 1622
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1622
Mailing Address - Country:US
Mailing Address - Phone:508-240-2828
Mailing Address - Fax:
Practice Address - Street 1:4205 STATEHIGHWAY
Practice Address - Street 2:
Practice Address - City:NORHT EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02651-1622
Practice Address - Country:US
Practice Address - Phone:508-240-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist