=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821936147
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER CUNNINGHAM RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 BAILEY ST NW STE 101
-----------------------------------------------------
City | MASSILLON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44646-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-737-8185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7230 CRUSADER ST SW
-----------------------------------------------------
City | MASSILLON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44646-9917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-737-8185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 31.010776
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------