Provider Demographics
NPI:1093769770
Name:CUMMING, CHRISTOPHER G (DMD, PHD, FDSRCS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:G
Last Name:CUMMING
Suffix:
Gender:M
Credentials:DMD, PHD, FDSRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 NORTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD FALLS
Mailing Address - State:KS
Mailing Address - Zip Code:66845-9888
Mailing Address - Country:US
Mailing Address - Phone:620-273-6236
Mailing Address - Fax:620-273-8931
Practice Address - Street 1:324 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-7164
Practice Address - Country:US
Practice Address - Phone:620-345-2100
Practice Address - Fax:620-273-8931
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
452101OtherBCBS OF KS
KS100344570CMedicaid
25965059OtherBCBS OF KANSAS CITY
481202402OtherPSKU TAX ID
KSK400277Medicare PIN
25965059OtherBCBS OF KANSAS CITY