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General NPI Number Information
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NPI Number | 1013176098
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Entity Type | Individual
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Provider Name | DANIEL SIMMONDS CANNON
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Gender | Male
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 3345 S HARVARD AVE STE 103
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City | TULSA
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State | OK
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Zip | 74135-1800
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Country | US
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Telephone | 918-743-1351
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Fax | 918-743-7329
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Provider Business Mailing Address
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Address Line | 3345 S HARVARD AVE STE 103
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City | TULSA
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State | OK
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Zip | 74135-1800
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Country | US
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Telephone | 918-743-1351
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Fax | 918-743-7329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 158
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License Number State | OK
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