Provider Demographics
NPI:1578686994
Name:CANNON, JAMES THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:CANNON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 CLARK RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3229
Mailing Address - Country:US
Mailing Address - Phone:941-404-4644
Mailing Address - Fax:866-397-8829
Practice Address - Street 1:5310 CLARK RD STE 207
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3229
Practice Address - Country:US
Practice Address - Phone:941-404-4644
Practice Address - Fax:866-397-8829
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL155421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice