Individual
MS. MICHELLE LEE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2217 E 8TH ST, SUPERIOR, WI 54880-3714
(218) 591-5716
Mailing address
2217 E 8TH ST, SUPERIOR, WI 54880-3714
(218) 591-5716
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5323-16
WI
124Q00000X
Dental Hygienist
H5621
MN
Other
Enumeration date
10/11/2011
Last updated
10/11/2011
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