Provider Demographics
NPI:1689015968
Name:CANNON, LAURA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:CANNON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W CHESTER PIKE
Mailing Address - Street 2:SUITE D-5
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7778
Mailing Address - Country:US
Mailing Address - Phone:610-692-9697
Mailing Address - Fax:610-692-8968
Practice Address - Street 1:1515 W CHESTER PIKE
Practice Address - Street 2:SUITE D-5
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7778
Practice Address - Country:US
Practice Address - Phone:610-692-9697
Practice Address - Fax:610-692-8968
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025819-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice