Healthcare Provider Details

I. General information

NPI: 1891700290
Provider Name (Legal Business Name): ALAN G INGERSOLL DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WEST 400 NORTH
OREM UT
84057
US

IV. Provider business mailing address

PO BOX 573
OREM UT
84057
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-1179
  • Fax: 801-225-0085
Mailing address:
  • Phone: 801-225-1179
  • Fax: 801-225-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number138355-9922
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALAN GRANT INGERSOLL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 801-225-1179