Provider Demographics
NPI:1417160342
Name:CUNNINGHAM, SIDNEY KIRK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:KIRK
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 1:801 E WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6646
Mailing Address - Country:US
Mailing Address - Phone:512-447-3501
Mailing Address - Fax:512-447-1811
Practice Address - Street 1:801 E WILLIAM CANNON DR
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6646
Practice Address - Country:US
Practice Address - Phone:512-447-3501
Practice Address - Fax:512-447-1811
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice