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General NPI Number Information
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NPI Number | 1629208921
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Entity Type | Individual
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Provider Name | JAY BRIAN CUNNINGHAM D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 2465 NEW HOLT ROAD
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City | PADUCAH
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State | KY
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Zip | 42001
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Country | US
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Telephone | 270-366-0735
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Fax | 270-366-0777
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Provider Business Mailing Address
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Address Line | 480 HIGHLAND CHURCH RD
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City | PADUCAH
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State | KY
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Zip | 42001-5917
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Country | US
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Telephone | 270-705-7702
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 8725
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License Number State | KY
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