Individual
CARSON CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2850 CURVE CREST BLVD W STE 200, STILLWATER, MN 55082-4073
(651) 439-9400
Mailing address
2850 CURVE CREST BLVD W, STILLWATER, MN 55082-4039
(651) 439-9400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1002126-15
WI
122300000X
Dentist
D14174
MN
1223G0001X
General Practice Dentistry
1002126-15
WI
1223G0001X
General Practice Dentistry
D14174
MN
Other
Enumeration date
05/14/2019
Last updated
02/04/2022
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