Provider Demographics
NPI:1538902499
Name:CUNNINGHAM, RAQUEL LAURYNE (DDS)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LAURYNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1313
Mailing Address - Country:US
Mailing Address - Phone:734-634-4154
Mailing Address - Fax:
Practice Address - Street 1:1014 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1092
Practice Address - Country:US
Practice Address - Phone:989-224-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist