MEDICARE: DR. GABRIEL BUCHANAN INGRAHAM III DMD

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	122300000X	Dentist	1940	SC
2	1223P0700X	Prosthodontics	242	SC

General Provider Information

NPI Number	:	1265553846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL BUCHANAN INGRAHAM III DMD

Provider Business Mailing Address
First Line	:	108 SOUTH CLEVELAND ST
Second Line	:
City	:	KERSHAW
State	:	SC
Zip	:	29067-1403
Country	:	US
Telephone Number	:	803-475-9440
Fax Number	:	803-475-3927

Provider Business Practice Location Address
First Line	:	108 SOUTH CLEVELAND ST
Second Line	:
City	:	KERSHAW
State	:	SC
Zip	:	29067-1403
Country	:	US
Telephone Number	:	803-475-9440
Fax Number	:	803-475-3927

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	09/11/2025

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