Provider Demographics
NPI:1629208921
Name:CUNNINGHAM, JAY BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BRIAN
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HIGHLAND CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5917
Mailing Address - Country:US
Mailing Address - Phone:270-705-7702
Mailing Address - Fax:
Practice Address - Street 1:2465 NEW HOLT ROAD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-366-0735
Practice Address - Fax:270-366-0777
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist