MEDICARE: HEATH LEE CUNNINGHAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7784	TN

General Provider Information

NPI Number	:	1245220961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATH LEE CUNNINGHAM DDS

Provider Business Mailing Address
First Line	:	1877 FORT CAMPBELL BLVD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-5109
Country	:	US
Telephone Number	:	931-648-0191
Fax Number	:	931-648-4235

Provider Business Practice Location Address
First Line	:	1877 FORT CAMPBELL BLVD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-5109
Country	:	US
Telephone Number	:	931-648-0191
Fax Number	:	931-648-4235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	10/15/2012

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