Healthcare Provider Details

I. General information

NPI: 1376256495
Provider Name (Legal Business Name): CUNNINGHAM & GAZDECK DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 UNIVERSITY DR STE D
DURHAM NC
27707-6224
US

IV. Provider business mailing address

3709 UNIVERSITY DR STE D
DURHAM NC
27707-6224
US

V. Phone/Fax

Practice location:
  • Phone: 919-489-8661
  • Fax:
Mailing address:
  • Phone: 919-489-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT KYLE GAZDECK
Title or Position: PRESIDENT/ OWNER
Credential: DDS
Phone: 919-489-8661