Daniel Simmonds Cannon

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

158 Issued in OK

Practice address

3345 S Harvard Ave Ste 103
Tulsa, OK 74135-1800

Phone

(918) 743-1351

Fax

(918) 743-7329

NPI assigned

Jun 5, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 16, 2025 through Jun 16, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: daniel.cannon@direct.stjohnhealthsystem.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1013176098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 S HARVARD AVE STE 103",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741351800",
            "telephone_number": "918-743-1351",
            "fax_number": "918-743-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 S HARVARD AVE STE 103",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741351800",
            "telephone_number": "918-743-1351",
            "fax_number": "918-743-7329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "DANIEL",
        "middle_name": "SIMMONDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachele B Cannavo
• Andy Allen Cannon, APRN
• Brandi Nicole Cannon, MA:MFT US
• Chad Michael Cannon, M.D.
• Changa H. Cannon, D.D.S.
• Jessica Cannon, LCSW
• Kathleen Sue Cannon, D.D.S.
• Michael Todd Cannon, DO
• Misty Dawn Cannon, NP
• Nicole Marie Cannon

• Oral and Maxillofacial Surgery (Dentist) in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.