Healthcare Provider Details

I. General information

NPI: 1073609574
Provider Name (Legal Business Name): INGE B FORD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 MARTIN LUTHER KING ST BLDG A
MOUND BAYOU MS
38762-9314
US

IV. Provider business mailing address

702 MARTIN LUTHER KING ST
MOUND BAYOU MS
38762-9314
US

V. Phone/Fax

Practice location:
  • Phone: 662-741-8857
  • Fax: 662-741-8806
Mailing address:
  • Phone: 662-741-8800
  • Fax: 662-741-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111695
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: