Organization
DISTINCTIVE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT RAY CUNNINGHAM JR. DMD (OWNER)
(803) 917-6962
Entity
Organization
Contact information
Practice address
11107 BROAD RIVER RD, SUITE D, IRMO, SC 29063-7602
(803) 749-3980
(803) 749-3981
Mailing address
11107 BROAD RIVER RD, SUITE D, IRMO, SC 29063-7602
(803) 749-3980
(803) 749-3981
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4114
SC
Other
Enumeration date
12/05/2007
Last updated
12/05/2007
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