# MAXINE CANNON DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cannon Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497562276
- **Authorized official:** DR. MAXINE ELAINE CANNON DDS (OWNER)
- **Authorized official phone:** (734) 787-8975

## Contact information

- **Practice address:** 1049 N MACOMB ST, MONROE, MI 48162-3126
- **Practice address phone:** (734) 242-4334
- **Mailing address:** 1790 EDSEL ST, TRENTON, MI 48183-1836
- **Mailing address phone:** (734) 787-8975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/16/2024
- **Last updated:** 12/19/2024