Provider Demographics
NPI:1669847992
Name:CRANDALL, AMARA (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:AMARA
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 CONTESSA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1732
Mailing Address - Country:US
Mailing Address - Phone:562-239-5027
Mailing Address - Fax:949-932-0455
Practice Address - Street 1:2710 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8750
Practice Address - Country:US
Practice Address - Phone:714-202-5648
Practice Address - Fax:949-932-0455
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics