MEDICARE: KATIE CUNNINGHAM, D.D.S., LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1790561835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATIE CUNNINGHAM, D.D.S., LLC

Provider Business Mailing Address
First Line	:	46 SAND RUN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-6200
Country	:	US
Telephone Number	:	330-867-7746
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 SAND RUN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-6200
Country	:	US
Telephone Number	:	330-867-7746
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KATIE CUNNINGHAM
Credential	:	DDS
Telephone Number	:	937-232-0532

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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