Provider Demographics
NPI:1790897221
Name:CUNNINGHAM, AIMEE CONCEPCION (DMD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:CONCEPCION
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:CONCEPCION
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-3917
Mailing Address - Fax:912-767-5425
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013365122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FC0072037OtherDEA