Provider Demographics
NPI:1205648680
Name:MCCANNEL, CYNTHIA MELISA (RDH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MELISA
Last Name:MCCANNEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:C
Other - Middle Name:MELISA
Other - Last Name:MCCANNEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:20728 31ST PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7829
Mailing Address - Country:US
Mailing Address - Phone:206-715-9424
Mailing Address - Fax:
Practice Address - Street 1:17395 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-8802
Practice Address - Country:US
Practice Address - Phone:360-466-3900
Practice Address - Fax:360-466-7301
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006267124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist