Individual
MR. DAVID L CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3015 HWY 29 S., SUITE 4176, ALEXANDRIA, MN 56308
(320) 763-5052
(320) 763-5053
Mailing address
4100 SHORELINE DR. #4, SPRING PARK, MN 55384
(952) 224-9784
(952) 224-9791
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11868
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
537439100
MN HEALTH PLANS PROVIDER
MN
Enumeration date
06/28/2006
Last updated
06/16/2014
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