Jeffrey Allen Crandall, D.D.S.
Individual provider Active NPI Oral and Maxillofacial Pathology Dentistry · South Burlington, VT
NPI 1790711414 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790711414
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Pathology Dentistry 1223P0106X
- License
- 615 (VT)
- Practice address
- 40 Timber LN
South Burlington, VT 05403-7204 - Phone
- (802) 862-7185
- Fax
- (802) 658-8036
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 615 | VT | MD | Oral and Maxillofacial Pathology Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 615 | VT | Yes |
Addresses
Primary practice location
40 Timber LN
South Burlington, VT 05403-7204
Mailing address
74 Maple RDG Rd
Underhill, VT 05489-9227
Phone (802) 899-2022
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001847 | Medicaid | VT |
Other providers in South Burlington, VT
- Richard Cordero
- Kristi Cornforth
- Leah McLane Costello
- Candis Joan Cousins
- Dominique J Couture-Sherman
- Evan Hayden Crandell
- Grace Samantha Crawford
- Shelley Ann Crombach
- Caitlin Margaret Cronin
- Christopher Wright Cronin
All providers in South Burlington, VT · Oral and Maxillofacial Pathology Dentistry in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.