Provider Demographics
NPI:1255399549
Name:CRANDALL, DENNIS G (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:G
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-962-0071
Mailing Address - Fax:480-962-0590
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-962-0071
Practice Address - Fax:480-962-0590
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22422207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167800Medicaid
AZF80090Medicare UPIN
AZ63465Medicare PIN