Matthew Cannavo, D.M.D

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901021268 Issued in MI

Practice address

7633 E Jefferson Ave
Suite 70
Detroit, MI 48214-3730

Phone

(313) 499-4775

Fax

(313) 499-4953

NPI assigned

Aug 27, 2014

Sex

Male

Sole proprietor

Yes

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

Enrolled in MI

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459209600000",
    "number": "1124428198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7633 E JEFFERSON AVE",
            "address_2": "SUITE 70",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482143730",
            "telephone_number": "313-499-4775",
            "fax_number": "313-499-4953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7633 E JEFFERSON AVE",
            "address_2": "SUITE 70",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482143730",
            "telephone_number": "313-499-4775",
            "fax_number": "313-499-4953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNAVO",
        "first_name": "MATTHEW",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-27",
        "last_updated": "2016-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901021268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Candela
• Steven Craig Candela, LMSW
• Canfield Pharmacy LLC
• Jamaal Edward Cann
• Nicole S Cann
• Carissa Cannon
• Christopher John Cannon, PHD
• Derrick Cannon, PT, DPT
• Ida Joyce Cannon
• Kayla D Cannon

• Oral and Maxillofacial Surgery (Dentist) in Detroit, MI
• Providers in Detroit, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.