Healthcare Provider Details

I. General information

NPI: 1265553846
Provider Name (Legal Business Name): GABRIEL BUCHANAN INGRAHAM III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SOUTH CLEVELAND ST
KERSHAW SC
29067-1403
US

IV. Provider business mailing address

108 SOUTH CLEVELAND ST
KERSHAW SC
29067-1403
US

V. Phone/Fax

Practice location:
  • Phone: 803-475-9440
  • Fax: 803-475-3927
Mailing address:
  • Phone: 803-475-9440
  • Fax: 803-475-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1940
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number242
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: