Provider Demographics
NPI:1386880896
Name:CUNNINGHAM, TALISHA H (DMD)
Entity type:Individual
Prefix:
First Name:TALISHA
Middle Name:H
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 W CALL ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3115
Mailing Address - Country:US
Mailing Address - Phone:904-964-5152
Mailing Address - Fax:904-964-9557
Practice Address - Street 1:459 W CALL ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3115
Practice Address - Country:US
Practice Address - Phone:904-964-5152
Practice Address - Fax:904-964-9557
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice