Provider Demographics
NPI:1295394914
Name:CUNNINGHAM, KANYON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KANYON
Middle Name:
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 1:2212 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4310
Mailing Address - Country:US
Mailing Address - Phone:580-225-5000
Mailing Address - Fax:
Practice Address - Street 1:2212 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4310
Practice Address - Country:US
Practice Address - Phone:580-225-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist