Individual provider Active NPI

Robert Peter Crannage III, DDS

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1801779665
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DB-2025-0143 Issued in NM
Practice address
2800 Coors Blvd NW Ste a
Albuquerque, NM 87120-1204
Phone
(505) 352-1166
Fax
(505) 352-2805
NPI assigned
Jul 29, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DB-2025-0143 NM Primary

Addresses

Primary practice location

2800 Coors Blvd NW Ste a
Albuquerque, NM 87120-1204

Mailing address

2800 Coors Blvd NW Ste a
Albuquerque, NM 87120-1204
Phone (505) 352-1166

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

LicenseStateTypeSpecialty
DB-2025-0143NMMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
CRDS PastSince Aug 3, 2025 Accepting new patients
Albuquerque Modern Dentistry, LLC General Practice PastSince Aug 3, 2025 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1801779665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 COORS BLVD NW STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201204",
            "telephone_number": "505-352-1166",
            "fax_number": "505-352-2805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 COORS BLVD NW STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201204",
            "telephone_number": "505-352-1166",
            "fax_number": "505-352-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANNAGE",
        "first_name": "ROBERT",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DB-2025-0143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.