Provider Demographics
NPI:1639578826
Name:CUNNINGHAM, KERRIE ELISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:ELISE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S TAFT HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4240
Mailing Address - Country:US
Mailing Address - Phone:970-482-6034
Mailing Address - Fax:
Practice Address - Street 1:721 W HUNTINGTON DR STE B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6734
Practice Address - Country:US
Practice Address - Phone:626-574-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202337122300000X
CADDS104748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist