Provider Demographics
NPI:1740593417
Name:CANNON, WILLIAM JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:CANNON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:W
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 805
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3106
Mailing Address - Country:US
Mailing Address - Phone:310-289-1989
Mailing Address - Fax:
Practice Address - Street 1:8500 WILSHIRE BLVD
Practice Address - Street 2:1018
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3121
Practice Address - Country:US
Practice Address - Phone:310-289-1989
Practice Address - Fax:310-289-1661
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS315821223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics