MEDICARE: DR. KRISTAN JOI INGRAHAM-MCQUEEN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	11944	CT

General Provider Information

NPI Number	:	1205215837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTAN JOI INGRAHAM-MCQUEEN D.M.D.

Provider Business Mailing Address
First Line	:	11128 FIELDSTONE DR
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-3890
Country	:	US
Telephone Number	:	203-722-3027
Fax Number	:

Provider Business Practice Location Address
First Line	:	10040 US HIGHWAY 301 N STE A
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-8493
Country	:	US
Telephone Number	:	914-229-8287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/05/2025

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