Healthcare Provider Details

I. General information

NPI: 1982173084
Provider Name (Legal Business Name): BRUCE E. CUNNINGHAM, DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 1ST AVE SW
JACKSONVILLE AL
36265-3329
US

IV. Provider business mailing address

1450 1ST AVE SW
JACKSONVILLE AL
36265-3329
US

V. Phone/Fax

Practice location:
  • Phone: 256-435-2007
  • Fax:
Mailing address:
  • Phone: 256-435-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVONNE CUNNINGHAM
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 256-435-2007