Maxine Cannon DDS, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MAXINE CANNON DDS, PLLC

Practice address

1049 N Macomb St
Monroe, MI 48162-3126

Phone

(734) 242-4334

NPI assigned

Dec 16, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Maxine Elaine Cannon, DDSNPI 1295221778

Title

Owner

Phone

(734) 787-8975

Specialties & licenses 1

Addresses

Other names 1

• Cannon Family Dental Doing business as

Locations

Practitioners 2

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

• Maxine Cannon, DDS

  • General Practice Dentistry
  • Monroe, MI
  • NPI 1295221778
  NPD Authorized official
• Gregory Alan Balog

  • Dentist
  • Monroe, MI
  • NPI 1932116134
  NPD (past)

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

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1497562276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 EDSEL ST",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481831836",
            "telephone_number": "734-787-8975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623126",
            "telephone_number": "734-242-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXINE CANNON DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "MAXINE",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-787-8975",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cannon Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Jean Mata, CNP
• Delford Mathews
• Shelby Mathison, PTA
• Melissa Mattes, LPN
• Yassin Mawari
• Rachelle Annette Maxwell, RN
• Brett Anthony May, D.O.
• Maywood Medical and Industrial Clinic, Inc.
• Carolyn McAllister, BA
• Megan McBee

• General Practice Dentistry in Monroe, MI
• Providers in Monroe, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.

Verify at the official NPI Registry.