Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 7704 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS042379 | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7704 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS042379 | PA |
NPI | 1508966961 |
---|---|
Provider Name | Dr. Larry L Cunningham JR. |
First Address | Pittsburgh, PA 15213-2523 |
Second Address | Pitsburgh, PA 15213-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 05/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0037835 | (02) | KY |
1036810350001 | (05) | PA |
U93476 | (02) | KY |