Individual
DR. MARK L CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
4160 RFD, GROVE MEDICAL CENTER, SUITE 308, LONG GROVE, IL 60047-9583
(847) 634-6166
Mailing address
4160 RFD, GROVE MEDICAL CENTER, LONG GROVE, IL 60047-9586
(847) 634-6166
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
IL
Other
Enumeration date
06/22/2006
Last updated
07/08/2007
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