Provider Demographics
NPI:1487782371
Name:CUNNINGHAM, DAVID JAMES (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
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 1:97 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1002
Mailing Address - Country:US
Mailing Address - Phone:641-236-5591
Mailing Address - Fax:
Practice Address - Street 1:825 BROAD ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2153
Practice Address - Country:US
Practice Address - Phone:641-236-6169
Practice Address - Fax:641-236-6041
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA73121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice