MEDICARE: DR. JAMES MICHAEL CUNNINGHAM DMD

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	6505	AL

General Provider Information

NPI Number	:	1922593888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL CUNNINGHAM DMD

Provider Business Mailing Address
First Line	:	2602 KIMBOLTON DR
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1236
Country	:	US
Telephone Number	:	205-317-3929
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 MIDTOWN DR
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-2719
Country	:	US
Telephone Number	:	979-846-7799
Fax Number	:

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

Provider Enumeration Date	:	06/24/2018
Last Update Date	:	06/15/2023

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