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General NPI Number Information
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NPI Number | 1851100143
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Entity Type | Organization
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Legal Business Name | INGRAM DENTAL CORPORATION
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 838 NORDAHL RD STE 275
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City | SAN MARCOS
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State | CA
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Zip | 92069-3600
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Country | US
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Telephone | 559-360-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 805 INVERLOCHY DR
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City | FALLBROOK
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State | CA
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Zip | 92028-4498
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ASHLEY INGRAM
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Credential |
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Telephone | 559-360-3391
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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 |
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License Number State |
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