Active NPI
Kelly Crenna, DDS
- Dentist
- Ann Arbor, MI
National Provider Identifier
1417308461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901022146
- Practice address
- 450 S Wagner Rd
Ann Arbor, MI 48103-1944 - Phone
- (734) 668-8420
- NPI assigned
- Jun 30, 2016
- Last updated
- Jun 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901022146 | MI | Primary |
Addresses
Primary practice location
450 S Wagner Rd
Ann Arbor, MI 48103-1944
Mailing address
450 S Wagner Rd
Ann Arbor, MI 48103-1944
Phone (734) 668-8420
Other practice location 1
2316 W Madison St
Chicago, IL 60612-2228
Phone (312) 909-9398
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170530000438 | MI | Order and Referring Only - Dentist | 5092000877 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crenna, PLLC | General Practice | Current | Accepting new patients |
| Ann Arbor Dental Care, PLLC | General Practice | Past | Accepting new patients |
Locations
450 S Wagner Rd
Ann Arbor, MI 48103
Phone (734) 668-8420
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1417308461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 S WAGNER RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481031944",
"telephone_number": "734-668-8420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 S WAGNER RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481031944",
"telephone_number": "734-668-8420"
}
],
"practiceLocations": [
{
"address_1": "2316 W Madison St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606122228",
"country_code": "US",
"telephone_number": "312-909-9398",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CRENNA",
"first_name": "KELLY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-30",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901022146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.