Provider Demographics
NPI:1508312950
Name:CANNON, DANIELLE SUIT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SUIT
Last Name:CANNON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-9677
Mailing Address - Country:US
Mailing Address - Phone:606-849-1999
Mailing Address - Fax:
Practice Address - Street 1:46 ASHBROOK DR
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9677
Practice Address - Country:US
Practice Address - Phone:606-849-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68721223G0001X
KY100311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice