Active NPI
Clinton R. Crandall, DDS
- Dentist
- Kennewick, WA
National Provider Identifier
1750646899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60290898
- Practice address
- 2611 S Quillan PL
Kennewick, WA 99338-1899 - Phone
- (509) 585-5437
- NPI assigned
- Jul 4, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE60290898 | WA | |
| Dentist | 122300000X | DE60290898 | WA | Primary |
Addresses
Primary practice location
2611 S Quillan PL
Kennewick, WA 99338-1899
Mailing address
PO Box 190
Toppenish, WA 98948-0190
Phone (509) 865-2395
Other practice location 1
1450 First Avenue SW
Quincy, WA 98848
Phone (509) 765-0674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- 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 |
|---|---|---|---|---|
| I20160425000741 | WA | Order and Referring Only - Dentist | 3375842495 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60290898 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777593600000",
"number": "1750646899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 190",
"city": "TOPPENISH",
"state": "WA",
"postal_code": "989480190",
"telephone_number": "509-865-2395",
"fax_number": "509-865-0757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2611 S QUILLAN PL",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993381899",
"telephone_number": "509-585-5437"
}
],
"practiceLocations": [
{
"address_1": "1450 First Avenue SW",
"address_purpose": "LOCATION",
"city": "Quincy",
"state": "WA",
"postal_code": "98848",
"country_code": "US",
"telephone_number": "509-765-0674",
"fax_number": "509-765-6591",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CRANDALL",
"first_name": "CLINTON",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-04",
"last_updated": "2026-05-01",
"certification_date": "2026-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE60290898",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60290898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennewick, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; 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.