Provider Demographics
NPI:1336205657
Name:CUNNINGHAM, JASON EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDGAR
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 1:510 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1393
Mailing Address - Country:US
Mailing Address - Phone:423-743-9133
Mailing Address - Fax:423-743-1928
Practice Address - Street 1:510 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1393
Practice Address - Country:US
Practice Address - Phone:423-743-9133
Practice Address - Fax:423-743-1928
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS77711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice