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General NPI Number Information
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NPI Number | 1962553362
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Entity Type | Individual
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Provider Name | EDWARD FRED INGERMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 530 BOSTON POST RD E STE D
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3645
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Country | US
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Telephone | 508-481-8094
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Fax | 508-481-8478
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Provider Business Mailing Address
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Address Line | 19 HYDER ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581-3722
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Country | US
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Telephone | 508-366-0759
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12693
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License Number State | MA
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