National Provider Identifier Database

DOMENIC M CANONICO, MD – NPI #1770551640
Plastic Surgery within the Head & Neck

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.


Contact Information

DOMENIC M CANONICO, MD
507 NW ATLANTIC ST
TULLAHOMA, TN37388-3504
Phone: 931-393-4332
Fax: 931-393-2304
Website:
Specialty Taxonomy Code
* Plastic Surgery within the Head & Neck 207YX0007X

* Indicates primary specialty

NPI Profile & details for DOMENIC M CANONICO

NPI Number 1770551640
Credentials MD
Entity Individual
Enumeration date 03/08/2006
Last updated 07/14/2015 - About 11 years ago
Sole proprietor1 No
Identifiers
  • TN License #: 18819
  • TN Medicaid: 3085592
  • TN Other: 0192943 BCBS
  • TN Other: 040013804 RAILROAD MEDICARE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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