Provider Demographics
NPI:1821151259
Name:MCCANN, DAVID E (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MCCANN
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 1:450 MILL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FONTANA
Mailing Address - State:WI
Mailing Address - Zip Code:53125-1242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 MILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FONTANA
Practice Address - State:WI
Practice Address - Zip Code:53125-1242
Practice Address - Country:US
Practice Address - Phone:262-275-8080
Practice Address - Fax:262-275-5890
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice