Healthcare Provider Details

I. General information

NPI: 1790897221
Provider Name (Legal Business Name): AIMEE CONCEPCION CUNNINGHAM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIMEE CONCEPCION CUNNINGHAM DMD

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/07/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-3917
  • Fax:
Mailing address:
  • Phone: 757-953-3917
  • Fax: 912-767-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013365
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN013365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: