Distinctive Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4114 Issued in SC

Legal business name

DISTINCTIVE DENTISTRY

Practice address

11107 Broad River Rd
Suite D
Irmo, SC 29063-7602

Phone

(803) 749-3980

Fax

(803) 749-3981

NPI assigned

Dec 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Ray Cunningham Jr., DMD

Title

Owner

Phone

(803) 917-6962

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1760664304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11107 BROAD RIVER RD",
            "address_2": "SUITE D",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290637602",
            "telephone_number": "803-749-3980",
            "fax_number": "803-749-3981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11107 BROAD RIVER RD",
            "address_2": "SUITE D",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290637602",
            "telephone_number": "803-749-3980",
            "fax_number": "803-749-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTINCTIVE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-917-6962",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genea Deshields Deshields Boykin, MSP CCC SLP
• John Dickinson
• Heather Diebold, PHARMD
• Shannon Dill-Williams, MSW
• Joanne Dimirra
• Ranarda Mishea Dixon, PHARMD
• Sandra Leahan Doar, LPC
• Kathleen Alice Doran, RN
• Jason Douglas, PHARMD
• Dr Rick Sanford Chiropractic and Medical Associates, LLC

• General Practice Dentistry in Irmo, SC
• Providers in Irmo, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.