Active NPI
Jodi L Crandall, DHAT
- Dental Therapist
- Wasilla, AK
National Provider Identifier
1679270748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Therapist
- License
- 23-173-DHAT
- Practice address
- 1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083 - Phone
- (190) 729-7690
- NPI assigned
- Feb 9, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Therapist | 125J00000X | 23-173-DHAT | AK | Primary |
Addresses
Primary practice location
1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083
Mailing address
1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083
Phone (190) 729-7690
Other names 1
- Jodi L Allen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-173-DHAT | AK | MD | Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675900800000",
"number": "1679270748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 S KNIK GOOSE BAY RD",
"city": "WASILLA",
"state": "AK",
"postal_code": "996548083",
"telephone_number": "190-729-7690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 S KNIK GOOSE BAY RD",
"city": "WASILLA",
"state": "AK",
"postal_code": "996548083",
"telephone_number": "190-729-7690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRANDALL",
"first_name": "JODI",
"middle_name": "L",
"credential": "DHAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-09",
"last_updated": "2023-02-09",
"certification_date": "2023-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "125J00000X",
"taxonomy_group": "",
"desc": "Dental Therapist",
"state": "AK",
"license": "23-173-DHAT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JODI",
"last_name": "ALLEN",
"middle_name": "L",
"credential": "DHAT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.