Provider Demographics
NPI:1851459242
Name:CUNNINGHAM, DEBORAH MARTINEZ (RDH)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MARTINEZ
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:340 PRINTERS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3190
Mailing Address - Country:US
Mailing Address - Phone:719-228-6635
Mailing Address - Fax:719-228-6612
Practice Address - Street 1:34 HYBROOK ROAD -SOUTH
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814
Practice Address - Country:US
Practice Address - Phone:719-687-4460
Practice Address - Fax:719-687-4457
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903812124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist