Healthcare Provider Details

I. General information

NPI: 1972693646
Provider Name (Legal Business Name): REGINA BETH CUNNINGHAM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA BETH HATFIELD DMD

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD BLDG 17, SUITE 6
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

2250 LEESTOWN RD BLDG 17, SUITE 6
LEXINGTON KY
40511-1052
US

V. Phone/Fax

Practice location:
  • Phone: 859-281-3912
  • Fax: 859-281-3984
Mailing address:
  • Phone: 859-281-3912
  • Fax: 859-281-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6885
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: