Provider Demographics
NPI:1245305499
Name:CANN, BETHANY (DMD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:CANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-6119
Mailing Address - Country:US
Mailing Address - Phone:269-615-6495
Mailing Address - Fax:
Practice Address - Street 1:401 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-6119
Practice Address - Country:US
Practice Address - Phone:269-615-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010192581223G0001X
PADS0366561223G0001X
HI21261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice