David L Cannon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11868 Issued in MN

Practice address

3015 Hwy 29 S.
Suite 4176
Alexandria, MN 56308

Phone

(320) 763-5052

Fax

(320) 763-5053

NPI assigned

Jun 28, 2006

Last updated

Jun 16, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402876800000",
    "number": "1801824040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 SHORELINE DR. #4",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "55384",
            "telephone_number": "952-224-9784",
            "fax_number": "952-224-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 HWY 29 S.",
            "address_2": "SUITE 4176",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-5052",
            "fax_number": "320-763-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "DAVID",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2014-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN HEALTH PLANS PROVIDER",
            "identifier": "537439100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica M Butanis, DO
• David W Butler, D.C.
• Lindsey Kopischke Buttweiler
• Brian Con Bymers, D.C.
• Rwanda Darby Campbell, MD
• Rita Marie Cannonwolf, B.A, T-ADC
• Cardinal Chiropractic of Alexandria LLC
• Brian D Carlsen, MD
• Christine Carlson
• Kent Arthur Carlson, MD

• General Practice Dentistry in Alexandria, MN
• Providers in Alexandria, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; 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.