MEDICARE: JACOB ALGRANATI DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	23709	MT

General Provider Information

NPI Number	:	1932858578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ALGRANATI DDS

Provider Business Mailing Address
First Line	:	11 MEADOW LN
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 GRAND AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-3302
Country	:	US
Telephone Number	:	406-655-3000
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	07/24/2023

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