Active NPI
Patricia Deanne Cannon, D.D.S.
- General Practice Dentistry
- Broken Arrow, OK
National Provider Identifier
1063404176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5218
- Practice address
- 411 W New Orleans St
Broken Arrow, OK 74011-2218 - Phone
- (918) 455-4242
- Fax
- (918) 455-4244
- NPI assigned
- Aug 16, 2005
- Reactivated
- Mar 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5218 | OK | Primary |
Addresses
Primary practice location
411 W New Orleans St
Broken Arrow, OK 74011-2218
Mailing address
411 W New Orleans St
Broken Arrow, OK 74011-2218
Phone (918) 455-4242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5218 | OK | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1063404176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 W NEW ORLEANS ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740112218",
"telephone_number": "918-455-4242",
"fax_number": "918-455-4244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 W NEW ORLEANS ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740112218",
"telephone_number": "918-455-4242",
"fax_number": "918-455-4244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "PATRICIA",
"middle_name": "DEANNE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-16",
"last_updated": "2026-07-13",
"deactivation_date": "2006-03-23",
"reactivation_date": "2006-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "5218",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.