Provider Demographics
NPI:1710960760
Name:PETER N CANNON DDS PA
Entity Type:Organization
Organization Name:PETER N CANNON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:651-224-2787
Mailing Address - Street 1:400 ROBERT ST N
Mailing Address - Street 2:#270
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2015
Mailing Address - Country:US
Mailing Address - Phone:651-224-2787
Mailing Address - Fax:651-223-5557
Practice Address - Street 1:400 ROBERT ST N
Practice Address - Street 2:#270
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2015
Practice Address - Country:US
Practice Address - Phone:651-224-2787
Practice Address - Fax:651-223-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty