Michelle Lynn Cannon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011767A Issued in IN

Practice address

710 Franklin St
Suite 200
Michigan City, IN 46360-3563

Phone

(219) 872-6200

Fax

(219) 379-2736

NPI assigned

Nov 5, 2009

Last updated

May 10, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336608000000",
    "number": "1629305065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 FRANKLIN ST",
            "address_2": "SUITE 200",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463603563",
            "telephone_number": "219-872-6200",
            "fax_number": "219-379-2736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 FRANKLIN ST",
            "address_2": "SUITE 200",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463603563",
            "telephone_number": "219-872-6200",
            "fax_number": "219-379-2736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2012-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.028140",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011767A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Bush
• James Callaghan III, M.D.
• Philip L Campagna Jr., DDS
• Darci Meyer Campbell, PTA
• Cancer Health Treatment Centers,P.C.
• Alexis Blake Cardenas, M.S. CCC-SLP
• Care at Home LLC
• Ralph M Caruso, DO
• Megan E Cary, LMT
• Catholic Charities

• General Practice Dentistry in Michigan City, IN
• Providers in Michigan City, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.