Healthcare Provider Details

I. General information

NPI: 1407019425
Provider Name (Legal Business Name): RICHARD P CUNNINGHAM, D.D.S., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N HIGH ST SUITE 1
WORTHINGTON OH
43085-2343
US

IV. Provider business mailing address

7227 N HIGH ST SUITE 1
WORTHINGTON OH
43085-2343
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-2022
  • Fax: 614-888-0284
Mailing address:
  • Phone: 614-885-2022
  • Fax: 614-888-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13652
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17188
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number14424
License Number StateOH

VIII. Authorized Official

Name: MELODY R THOMAS
Title or Position: BUSINESS ADMINSTRATOR
Credential:
Phone: 614-885-2022