Healthcare Provider Details

I. General information

NPI: 1962852459
Provider Name (Legal Business Name): JAMES O CUNNINGTON DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 JEFFERSON ST
PORT TOWNSEND WA
98368-5819
US

IV. Provider business mailing address

835 JEFFERSON ST
PORT TOWNSEND WA
98368-5819
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-1140
  • Fax: 360-385-1277
Mailing address:
  • Phone: 360-385-1140
  • Fax: 360-385-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00005349
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES OWEN CUNNINGTON II
Title or Position: OWNER
Credential: DDS
Phone: 360-385-1140