Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1418301 | IL |
NPI | 1013176098 |
---|---|
Provider Name | Daniel Simmonds Cannon |
First Address | Urbana, IL 61801 |
Second Address | Urbana, IL 61801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 05/06/2008 |