Healthcare Provider Details

I. General information

NPI: 1063323772
Provider Name (Legal Business Name): JUSTIN MICHAEL CUNNINGHAM, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15716 PROFESSIONAL PLZ
HAMMOND LA
70403-1451
US

IV. Provider business mailing address

15716 PROFESSIONAL PLZ
HAMMOND LA
70403-1451
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-8484
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. JUSTIN MICHAEL CUNNINGHAM
Title or Position: OWNER
Credential: DDS
Phone: 504-610-9426