MEDICARE: DR. STUART 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	1223G0001X	General Practice Dentistry	030324	NY

General Provider Information

NPI Number	:	1528280948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART GRABER D.D.S.

Provider Business Mailing Address
First Line	:	631 LONG RIDGE RD
Second Line	:	UNIT 23
City	:	STAMFORD
State	:	CT
Zip	:	06902-1258
Country	:	US
Telephone Number	:	914-391-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 HILL BLVD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1283
Country	:	US
Telephone Number	:	914-245-3103
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	09/13/2009

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