1831377704 NPI number — DR. RUSSELL D CUNNINGHAM DDS MD

Table of content: DR. RUSSELL D CUNNINGHAM DDS MD (NPI 1831377704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831377704 NPI number — DR. RUSSELL D CUNNINGHAM DDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
RUSSELL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831377704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 49500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78765-9500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-498-0114
Provider Business Mailing Address Fax Number:
512-467-0363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LAKEWAY CENTRE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWAY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78734-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-263-9544
Provider Business Practice Location Address Fax Number:
512-263-9549
Provider Enumeration Date:
02/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  20912 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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