Individual provider Active NPI

David H Cannon, DDS

  • General Practice Dentistry
  • Salt Lake City, UT
National Provider Identifier
1619046117
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
139950-9922 Issued in UT
Practice address
1060 E 100 S
Suite 307
Salt Lake City, UT 84102-1501
Phone
(801) 363-1321
Fax
(801) 322-0884
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 139950-9922 UT Primary

Addresses

Primary practice location

1060 E 100 S
Suite 307
Salt Lake City, UT 84102-1501

Mailing address

1060 E 100 S
Suite 307
Salt Lake City, UT 84102-1501
Phone (801) 363-1321

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20150624002611 UT Order and Referring Only - DentistPractitioner - Dentist 7214248780

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
139950-9922UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619046117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 E 100 S",
            "address_2": "SUITE 307",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021501",
            "telephone_number": "801-363-1321",
            "fax_number": "801-322-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 E 100 S",
            "address_2": "SUITE 307",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021501",
            "telephone_number": "801-363-1321",
            "fax_number": "801-322-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "DAVID",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "139950-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.