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1194062703 NPI number — LISA MARIE INGRAM D.D.S.

NPI Number: 1194062703
Health Care Provider/Practitioner: LISA MARIE INGRAM D.D.S.

Information about “1194062703” NPI (LISA MARIE INGRAM D.D.S.) exists in 1194062703 in HTML format HTML  |  1194062703 in plain Text format TXT  |  1194062703 in PDF (Portable Document Format) PDF  |  1194062703 in an XML format XML  formats.

NPI Number : 1194062703 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194062703",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "INGRAM",
    "FirstName": "LISA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DUGAN",
    "OtherFirstName": "LISA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1015 E 16TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WELLINGTON",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67152-2812",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "620-326-5751",
    "MailingAddressFaxNumber": "620-399-8917",
    "FirstLinePracticeLocationAddress": "1015 E 16TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WELLINGTON",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "67152-2812",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "620-326-5751",
    "PracticeLocationAddressFaxNumber": "620-399-8917",
    "EnumerationDate": "01/16/2013",
    "LastUpdateDate": "11/07/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "61022",
        "LicenseNumberStateCode": "KS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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