Healthcare Provider Details

I. General information

NPI: 1518892702
Provider Name (Legal Business Name): MIO EMERSON MCGREGOR CANNON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SE DE BELL AVE
BARTLESVILLE OK
74006
US

IV. Provider business mailing address

140 SE DE BELL AVE
BARTLESVILLE OK
74006
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-1576
  • Fax:
Mailing address:
  • Phone: 918-333-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8230
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: