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General NPI Number Information
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NPI Number | 1073190633
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Entity Type | Individual
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Provider Name | ERIK CANNON DMD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 08/07/2022
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Provider Practice Location Address
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Address Line | 350 ROUTE 73 S
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City | MARLTON
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State | NJ
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Zip | 08053-2004
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Country | US
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Telephone | 856-983-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 59 GREENBRIAR DR
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City | DALLAS
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State | PA
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Zip | 18612-9119
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Country | US
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Telephone | 570-574-1982
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02889900
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License Number State | NJ
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