Provider Demographics
NPI:1952813727
Name:CUNNINGHAM, FALLON ANDREA (DDS)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:ANDREA
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 1:8956 162ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5072
Mailing Address - Country:US
Mailing Address - Phone:718-657-1100
Mailing Address - Fax:718-657-1870
Practice Address - Street 1:3411 VERNON BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-5121
Practice Address - Country:US
Practice Address - Phone:347-630-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist