Healthcare Provider Details

I. General information

NPI: 1811713621
Provider Name (Legal Business Name): CREIGH CRANDALL DDS WALDORF PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HIGH ST STE A
WALDORF MD
20602-2191
US

IV. Provider business mailing address

83 HIGH ST STE A
WALDORF MD
20602-2191
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-3601
  • Fax:
Mailing address:
  • Phone: 301-645-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CREIGH CRANDALL
Title or Position: DOCTOR OWNER
Credential: DDS
Phone: 773-354-0342