MEDICARE: DR. CARLOS ALBERTO GRANA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	1832	PR

General Provider Information

NPI Number	:	1275618605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ALBERTO GRANA DMD

Provider Business Mailing Address
First Line	:	PO BOX 173
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-0173
Country	:	US
Telephone Number	:	787-264-2810
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CALLE HERNAN ALVAREZ
Second Line	:	SUITE 201
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4173
Country	:	US
Telephone Number	:	787-264-2810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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