Provider Demographics
NPI:1023011855
Name:CUNNINGHAM, THOMAS ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALAN
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 POINTE PL
Mailing Address - Street 2:STE 102
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4652
Mailing Address - Country:US
Mailing Address - Phone:770-772-9999
Mailing Address - Fax:770-442-6768
Practice Address - Street 1:11775 POINTE PL
Practice Address - Street 2:STE 102
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4652
Practice Address - Country:US
Practice Address - Phone:770-772-9999
Practice Address - Fax:770-442-6768
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice