Provider Demographics
NPI:1720138886
Name:MCCANN, CHARLES MORGAN (DDS MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MORGAN
Last Name:MCCANN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 401 MEDICAL ARTS BUILDING
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2611
Mailing Address - Country:US
Mailing Address - Phone:612-339-5593
Mailing Address - Fax:612-339-5594
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 401 MEDICAL ARTS BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2611
Practice Address - Country:US
Practice Address - Phone:612-339-5593
Practice Address - Fax:612-339-5594
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NED112951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics