Healthcare Provider Details

I. General information

NPI: 1932802741
Provider Name (Legal Business Name): BRIANNA CHRISTINE INGRAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 COMPUTER DR STE 101
RALEIGH NC
27609-6518
US

IV. Provider business mailing address

3809 COMPUTER DR STE 101
RALEIGH NC
27609-6518
US

V. Phone/Fax

Practice location:
  • Phone: 919-298-2820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13630
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License Number13630
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: