Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 19583 | TX |
NPI | 1013307511 |
---|---|
Provider Name | Dr. Jennifer Cunningham |
First Address | Houston, TX 77005-4141 |
Second Address | Houston, TX 77005-4141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2015 |
Last Update Date | 04/02/2015 |