Provider Demographics
NPI:1063944999
Name:CANNON, LINDA GIORDANO (RDH)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:GIORDANO
Last Name:CANNON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18403 LAKECREST CT
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1933
Mailing Address - Country:US
Mailing Address - Phone:510-378-3970
Mailing Address - Fax:
Practice Address - Street 1:18403 LAKECREST CT
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-1933
Practice Address - Country:US
Practice Address - Phone:510-378-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2022-08-10
Deactivation Date:2022-05-31
Deactivation Code:
Reactivation Date:2022-07-19
Provider Licenses
StateLicense IDTaxonomies
CARDH11986124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist