Provider Demographics
NPI:1558684472
Name:CANNON, HYRUM M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HYRUM
Middle Name:M
Last Name:CANNON
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 1:55 E 2200 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5619
Mailing Address - Country:US
Mailing Address - Phone:801-295-5115
Mailing Address - Fax:801-397-5559
Practice Address - Street 1:55 E 2200 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5619
Practice Address - Country:US
Practice Address - Phone:801-295-5115
Practice Address - Fax:801-397-5559
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584331223G0001X
UT75964131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice