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David L Cannon

Dentist

Dental Providers

3015 Hwy 29 S., Suite 4176, Alexandria, MN 56308

PECOS Enrollment

This provider is enrolled in PECOS as DAVID CANNON.

Based on the most recent information from CMS, provider David L Cannon is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1801824040
Provider Type
Individual
Full Name
Cannon, David L
Title
Mr.
Credential
DDS

Gender
Male
Sole Proprietor
No
Enumeration Date
6/28/2006
Last Updated
6/16/2014

Contact Information

Practice Location

3015 Hwy 29 S., Suite 4176, Alexandria, MN 56308

(320) 763-5052

(320) 763-5053

Mailing Location

4100 Shoreline Dr. #4, Spring Park, MN 55384

(952) 224-9784

(952) 224-9791

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 11868 Minnesota

Provider Identifiers

ID	Description	Issuer
ID 537439100	Description Other	Issuer MN HEALTH PLANS PROVIDER Minnesota

David L Cannon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Aberle, Jacob Rodney

Dean R. Anderson Dds Pc

Dental Health Associates Of Alexandria Mn

Dewitt, Thomas C

Family & Cosmetic Gentle Dentistry, Ltd

Rauk, Kimberly Ann

Quam, Alan Douglas

Anderson, Dean Richard

Dentistry At The Center

Einerson, Lowell Everett