Provider Demographics
NPI:1306108295
Name:CUNNINGHAM, RAYMOND SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:SCOTT
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 WATER ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4645
Mailing Address - Country:US
Mailing Address - Phone:207-623-3400
Mailing Address - Fax:207-623-3440
Practice Address - Street 1:269 WATER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4645
Practice Address - Country:US
Practice Address - Phone:207-623-3400
Practice Address - Fax:207-623-3440
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN42841223G0001X
OH30.0237271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice