Shannon Carol Cunningham, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11160 Issued in MN

Practice address

7430 80TH St S
Suite 202
Cottage Grove, MN 55016-3035

Phone

(651) 459-6884

Fax

(651) 459-5670

NPI assigned

Sep 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770681173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1956 JULIET AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7430 80TH ST S",
            "address_2": "SUITE 202",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550163035",
            "telephone_number": "651-459-6884",
            "fax_number": "651-459-5670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "SHANNON",
        "middle_name": "CAROL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cottage Grove Smiles Dentistry, PC (Cottage Grove Smiles Dentistry)
• Cottage Grove WP, LLC
• Jodi J Cowan, LPC
• Sarah Crandall, L.M.T.
• Diane Vavrik Crater, DDS
• Linda M Cutler, AMP
• Terecha Abebe Damesse, RN
• Kyle Davenport
• Sarah Davis, LCSW
• Deep Harmony Home Care LLC

• General Practice Dentistry in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.