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: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

IV. Provider business mailing address

2480 VINE ST APT 3
LINCOLN NE
68503-2586
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1333
  • Fax: 402-472-1225
Mailing address:
  • Phone: 484-661-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7955
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: