Healthcare Provider Details

I. General information

NPI: 1437697125
Provider Name (Legal Business Name): LAUREN K. CUNNINGHAM DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E IDAHO AVE STE 23
LAS CRUCES NM
88005-3242
US

IV. Provider business mailing address

225 E IDAHO AVE STE 23
LAS CRUCES NM
88005-3242
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-8556
  • Fax: 575-525-8724
Mailing address:
  • Phone: 575-524-8556
  • Fax: 575-525-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2643
License Number StateNM

VIII. Authorized Official

Name: DR. LAUREN CUNNINGHAM
Title or Position: MEMBER
Credential: DDS
Phone: 575-993-3454