MEDICARE: DR. CHARLES MORGAN MCCANN DDS MS

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	1223P0300X	Periodontics	D11295	NE

General Provider Information

NPI Number	:	1720138886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MORGAN MCCANN DDS MS

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 401 MEDICAL ARTS BUILDING
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2611
Country	:	US
Telephone Number	:	612-339-5593
Fax Number	:	612-339-5594

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 401 MEDICAL ARTS BUILDING
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2611
Country	:	US
Telephone Number	:	612-339-5593
Fax Number	:	612-339-5594

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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