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General NPI Number Information
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NPI Number | 1275940686
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Entity Type | Individual
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Provider Name | TARHONDA LEAH INGRAM DMD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 112 VILSECK ROAD, BLDG. 419-2
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City | FT. STEWART
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State | GA
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Zip | 31315
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Country | US
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Telephone | 912-257-7056
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Fax | 912-257-7055
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Provider Business Mailing Address
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Address Line | 1061 HARMON AVE US ARMY DENTAL HEALTH ACTIVITY
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone | 912-435-7006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN014799
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License Number State | GA
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