MEDICARE: KARLY ELIZABETH CANNEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1002244	WI

General Provider Information

NPI Number	:	1417449141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLY ELIZABETH CANNEY DDS

Provider Business Mailing Address
First Line	:	230 S WASHINGTON ST
Second Line	:
City	:	SAINT CROIX FALLS
State	:	WI
Zip	:	54024-4417
Country	:	US
Telephone Number	:	952-220-9925
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 S WASHINGTON ST
Second Line	:
City	:	SAINT CROIX FALLS
State	:	WI
Zip	:	54024-4417
Country	:	US
Telephone Number	:	952-220-9925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	02/10/2026

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