Healthcare Provider Details

I. General information

NPI: 1891936944
Provider Name (Legal Business Name): GEOFFREY ROSS CUNNINGHAM DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E BENJAMIN DR
NEW MARTINSVILLE WV
26155-2705
US

IV. Provider business mailing address

1240 VAN VOORHIS RD APT L3
MORGANTOWN WV
26505-7903
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-5644
  • Fax:
Mailing address:
  • Phone: 704-224-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3470
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7260
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: