Active NPI
Jason Nicholas Cannon, DDS
- General Practice Dentistry
- Kernersville, NC
National Provider Identifier
1396580288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13792
- Practice address
- 851 Old Winston Rd Ste 101
Kernersville, NC 27284-8781 - Phone
- (336) 996-7770
- NPI assigned
- Jul 1, 2024
- Sex
- Male
- 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 | 13792 | NC | Primary |
Addresses
Primary practice location
851 Old Winston Rd Ste 101
Kernersville, NC 27284-8781
Mailing address
851 Old Winston Rd Ste 101
Kernersville, NC 27284-8781
Phone (336) 996-7770
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 |
|---|---|---|---|
| 13792 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jesse a. Grimm,DDS PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Kernersville, NC
- NPI 1225216377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1396580288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 OLD WINSTON RD STE 101",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272848781",
"telephone_number": "336-996-7770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 OLD WINSTON RD STE 101",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272848781",
"telephone_number": "336-996-7770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "JASON",
"middle_name": "NICHOLAS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-01",
"last_updated": "2024-07-15",
"certification_date": "2024-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "13792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.