Provider Demographics
NPI:1013062504
Name:CUNNINGHAM, MICHAEL TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TAYLOR
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3503
Mailing Address - Country:US
Mailing Address - Phone:540-943-4215
Mailing Address - Fax:540-949-6519
Practice Address - Street 1:365 S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3503
Practice Address - Country:US
Practice Address - Phone:540-943-4215
Practice Address - Fax:540-949-6519
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist