Provider Demographics
NPI:1538350210
Name:CUNNINGHAM, CARLY CHRISTEN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:CHRISTEN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 BENNEY LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5268
Mailing Address - Country:US
Mailing Address - Phone:512-858-1311
Mailing Address - Fax:512-858-7505
Practice Address - Street 1:131 BENNEY LN UNIT A
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5268
Practice Address - Country:US
Practice Address - Phone:512-858-1311
Practice Address - Fax:512-858-7505
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics