Healthcare Provider Details

I. General information

NPI: 1366334690
Provider Name (Legal Business Name): JUSTIN MICHAEL CUNNINGHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
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: 985-542-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7695
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: