Provider Demographics
NPI:1700229051
Name:CUNNINGHAM DENTAL PLLC
Entity Type:Organization
Organization Name:CUNNINGHAM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-705-7702
Mailing Address - Street 1:4570 PECAN DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7501
Mailing Address - Country:US
Mailing Address - Phone:270-366-0735
Mailing Address - Fax:270-366-0777
Practice Address - Street 1:4570 PECAN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7501
Practice Address - Country:US
Practice Address - Phone:270-366-0735
Practice Address - Fax:270-366-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY87251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty