Provider Demographics
NPI:1508966961
Name:CUNNINGHAM, LARRY L JR (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:CUNNINGHAM
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3501 TERRACE STREET
Mailing Address - Street 2:SUITE 3189
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2523
Mailing Address - Country:US
Mailing Address - Phone:412-648-9100
Mailing Address - Fax:412-383-7862
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:SUITE 3189
Practice Address - City:PITSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2523
Practice Address - Country:US
Practice Address - Phone:412-648-9100
Practice Address - Fax:412-383-7862
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY77041223S0112X, 204E00000X
PADS042379204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036810350001Medicaid
KY64042757Medicaid
KYU93476Medicare UPIN
KY64042757Medicaid