Provider Demographics
NPI:1245392604
Name:MCCAN, DAMON D (DDS)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:D
Last Name:MCCAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2928
Mailing Address - Country:US
Mailing Address - Phone:715-855-9220
Mailing Address - Fax:715-855-9225
Practice Address - Street 1:4605 ROYAL DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2928
Practice Address - Country:US
Practice Address - Phone:715-855-9220
Practice Address - Fax:715-855-9225
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice