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NPI Code Detail

MEDICARE: DR. DANIEL WALTER INGRAM DDS

MEDICARE: DR. DANIEL WALTER INGRAM DDS
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
1122300000XDentist05288VA

General Provider Information

NPI Number : 1376764605
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL WALTER INGRAM DDS
Provider Business Mailing Address
First Line : 1212 LAKE JAMES DR
Second Line : SUITE A
City : VIRGINIA BEACH
State : VA
Zip : 23464-6779
Country : US
Telephone Number : 757-420-4214
Fax Number :
Provider Business Practice Location Address
First Line : 1212 LAKE JAMES DR
Second Line : SUITE A
City : VIRGINIA BEACH
State : VA
Zip : 23464-6779
Country : US
Telephone Number : 757-420-4214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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Directions to “ DR. DANIEL WALTER INGRAM DDS” Practice Location

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