Healthcare Provider Details

I. General information

NPI: 1952813727
Provider Name (Legal Business Name): FALLON ANDREA CUNNINGHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13519 MICHIGAN AVE
DEARBORN MI
48126-3510
US

IV. Provider business mailing address

8956 162ND ST FL 3
JAMAICA NY
11432-5072
US

V. Phone/Fax

Practice location:
  • Phone: 313-633-9318
  • Fax:
Mailing address:
  • Phone: 718-657-1100
  • Fax: 718-657-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number060687
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901602780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: