Provider Demographics
NPI:1952422784
Name:CRANDALL, DAWN ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ANN
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4534
Mailing Address - Country:US
Mailing Address - Phone:703-368-1000
Mailing Address - Fax:703-331-4944
Practice Address - Street 1:8719 STONEWALL RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4534
Practice Address - Country:US
Practice Address - Phone:703-368-1000
Practice Address - Fax:703-331-4944
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA71791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639133291Medicaid