Provider Demographics
NPI:1205231644
Name:CUMMINGS, JOHN LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEWIS
Last Name:CUMMINGS
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 1:58457 29 PALMS HWY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5879
Mailing Address - Country:US
Mailing Address - Phone:760-365-3338
Mailing Address - Fax:760-365-5418
Practice Address - Street 1:58457 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5879
Practice Address - Country:US
Practice Address - Phone:760-365-3338
Practice Address - Fax:760-365-5418
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist