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General NPI Number Information
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NPI Number | 1770681173
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Entity Type | Individual
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Provider Name | SHANNON CAROL CUNNINGHAM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7430 80TH ST S SUITE 202
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3035
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Country | US
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Telephone | 651-459-6884
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Fax | 651-459-5670
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Provider Business Mailing Address
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Address Line | 1956 JULIET AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-1722
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D11160
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License Number State | MN
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