Individual
DR. MICHAEL LAWRENCE GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
138 CHURCH ST NE, VIENNA, VA 22180-4543
(703) 938-6022
(703) 938-6039
Mailing address
138 CHURCH ST NE, VIENNA, VA 22180-4543
(703) 938-6022
(703) 938-6039
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6214
VA
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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