Provider Demographics
NPI:1780947879
Name:CUNNINGHAM, PRIYA GOYAL (DMD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:GOYAL
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 S ACOMA ST
Mailing Address - Street 2:APT 476
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1592
Mailing Address - Country:US
Mailing Address - Phone:248-342-8954
Mailing Address - Fax:
Practice Address - Street 1:3494 EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-7403
Practice Address - Country:US
Practice Address - Phone:303-659-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19793122300000X
CODEN.00202521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist