Provider Demographics
NPI:1548884919
Name:GRABAN, DYLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:GRABAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 BROADVUE CIR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8565
Mailing Address - Country:US
Mailing Address - Phone:740-454-6705
Mailing Address - Fax:
Practice Address - Street 1:3205 BROADVUE CIR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8565
Practice Address - Country:US
Practice Address - Phone:740-454-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0261621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice