Provider Demographics
NPI:1972693646
Name:CUNNINGHAM, REGINA BETH (DMD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:BETH
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:BETH
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2250 LEESTOWN RD
Mailing Address - Street 2:BLDG 17, SUITE 6
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1052
Mailing Address - Country:US
Mailing Address - Phone:859-281-3912
Mailing Address - Fax:859-281-3984
Practice Address - Street 1:2250 LEESTOWN RD
Practice Address - Street 2:BLDG 17, SUITE 6
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1052
Practice Address - Country:US
Practice Address - Phone:859-281-3912
Practice Address - Fax:859-281-3984
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY68851223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU91899Medicare UPIN