Provider Demographics
NPI:1861104036
Name:CRENNA, PLLC
Entity type:Organization
Organization Name:CRENNA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:CRENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-668-8420
Mailing Address - Street 1:450 WAGNER ROAD
Mailing Address - Street 2:
Mailing Address - City:AND ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-668-8420
Mailing Address - Fax:734-668-1397
Practice Address - Street 1:450 WAGNER ROAD
Practice Address - Street 2:
Practice Address - City:AND ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-668-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty