NPIMap

Organization Active NPI

Clay D Cannon, DDS, PLLC

  • General Practice Dentistry
  • Tyler, TX
National Provider Identifier
1245436187
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
18036 Issued in TX
Legal business name
CLAY D CANNON, DDS, PLLC
Practice address
202 Shelley Dr
Tyler, TX 75701-8725
Phone
(903) 561-8600
NPI assigned
Jun 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Clay Cannon, DDSNPI 1427261346
Title
Owner
Phone
(903) 561-8600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 18036 TX Primary

Addresses

Primary practice location

202 Shelley Dr
Tyler, TX 75701-8725

Mailing address

202 Shelley Dr
Tyler, TX 75701-8725
Phone (903) 561-8600

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245436187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 SHELLEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018725",
            "telephone_number": "903-561-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SHELLEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018725",
            "telephone_number": "903-561-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY D CANNON, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "CLAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-561-8600",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.