Active NPI
Colton Cannon
- Dentist
- La Grange Park, IL
National Provider Identifier
1801590807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.035872
- Practice address
- 539 N la Grange Rd
La Grange Park, IL 60526-5647 - Phone
- (708) 354-1070
- NPI assigned
- Mar 27, 2023
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.035872 | IL | Primary |
Addresses
Primary practice location
539 N la Grange Rd
La Grange Park, IL 60526-5647
Mailing address
3400 Spruce St
Philadelphia, PA 19104-4238
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783555200000",
"number": "1801590807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "539 N LA GRANGE RD",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605265647",
"telephone_number": "708-354-1070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "COLTON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-27",
"last_updated": "2026-07-09",
"certification_date": "2026-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.035872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.