Provider Demographics
NPI:1962852459
Name:JAMES O CUNNINGTON DDS
Entity Type:Organization
Organization Name:JAMES O CUNNINGTON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:CUNNINGTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-385-1140
Mailing Address - Street 1:835 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-5819
Mailing Address - Country:US
Mailing Address - Phone:360-385-1140
Mailing Address - Fax:360-385-1277
Practice Address - Street 1:835 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5819
Practice Address - Country:US
Practice Address - Phone:360-385-1140
Practice Address - Fax:360-385-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005349122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0000000000Medicare NSC