MEDICARE: DR. MORDECHAI GRABER D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	050751	NY

General Provider Information

NPI Number	:	1467775114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORDECHAI GRABER D.D.S.

Provider Business Mailing Address
First Line	:	2635 NOSTRAND AVE
Second Line	:	SUITE L2
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4641
Country	:	US
Telephone Number	:	718-535-7090
Fax Number	:	718-535-7033

Provider Business Practice Location Address
First Line	:	2635 NOSTRAND AVE
Second Line	:	SUITE L2
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4641
Country	:	US
Telephone Number	:	718-535-7090
Fax Number	:	718-535-7033

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	10/14/2010

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