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General NPI Number Information
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NPI Number | 1205278892
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Entity Type | Individual
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Provider Name | JACQUELINE D CUNNINGHAM RDH
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 3460 LIBERTY RD S
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City | SALEM
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State | OR
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Zip | 97302-4607
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Country | US
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Telephone | 503-371-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 WALLACE RD NW APT 14
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City | SALEM
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State | OR
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Zip | 97304-3078
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Country | US
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Telephone | 503-991-4406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H6478
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH61023
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License Number State | OH
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