MEDICARE: DR. LAUREN KILEY CUNNINGHAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD2643	NM

General Provider Information

NPI Number	:	1598752214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN KILEY CUNNINGHAM DDS

Provider Business Mailing Address
First Line	:	2205 S SOLANO DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5503
Country	:	US
Telephone Number	:	505-522-7320
Fax Number	:	505-522-6395

Provider Business Practice Location Address
First Line	:	2205 S SOLANO DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5503
Country	:	US
Telephone Number	:	505-522-7320
Fax Number	:	505-522-6395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/19/2007

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