Provider Demographics
NPI:1790947547
Name:MCCUNE, VIRGINIA KING (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:KING
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:FAVROT
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 PINETREE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5068
Mailing Address - Country:US
Mailing Address - Phone:706-364-6585
Mailing Address - Fax:
Practice Address - Street 1:1750 PINETREE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5068
Practice Address - Country:US
Practice Address - Phone:706-364-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist