Healthcare Provider Details

I. General information

NPI: 1780367920
Provider Name (Legal Business Name): DR. GREGORY RYAN INGALSBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 LIMESTONE RD STE 203
WILMINGTON DE
19808-2151
US

IV. Provider business mailing address

17132 JOLENE LANDING CT
MILTON DE
19968-3965
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-6979
  • Fax:
Mailing address:
  • Phone: 484-661-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberG1-0011670
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: