Provider Demographics
NPI:1942597364
Name:CRANDALL, TERESA K (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-3534
Mailing Address - Country:US
Mailing Address - Phone:207-793-8881
Mailing Address - Fax:
Practice Address - Street 1:26 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:ME
Practice Address - Zip Code:04048
Practice Address - Country:US
Practice Address - Phone:207-793-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH 3114124Q00000X
MELAN322124Q00000X
MEIPH30124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist