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General NPI Number Information
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NPI Number | 1811713621
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Entity Type | Organization
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Legal Business Name | CREIGH CRANDALL DDS WALDORF PC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 83 HIGH ST STE A
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City | WALDORF
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State | MD
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Zip | 20602-2191
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Country | US
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Telephone | 301-645-3601
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Fax |
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Provider Business Mailing Address
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Address Line | 83 HIGH ST STE A
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City | WALDORF
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State | MD
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Zip | 20602-2191
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Country | US
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Telephone | 301-645-3601
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CREIGH CRANDALL
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Credential | DDS
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Telephone | 773-354-0342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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