David S Cannon, DDS
Individual provider Active NPI Dentist · Holladay, UT
NPI 1295743763 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295743763
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 4949645 (UT)
- Practice address
- 1434 E 4500 S
#202
Holladay, UT 84117 - Phone
- (801) 274-8889
- Fax
- (801) 274-3896
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4949645 | UT | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4949645 | UT | Yes |
Addresses
Primary practice location
1434 E 4500 S
#202
Holladay, UT 84117
Mailing address
1434 E 4500 S
#202
Holladay, UT 84117
Phone (801) 274-8889
Other providers in Holladay, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.