MEDICARE: INGERSOLL FAMILY DENTISTRY

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1538828678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGERSOLL FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2800 INGERSOLL AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-4013
Country	:	US
Telephone Number	:	515-243-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 INGERSOLL AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-4013
Country	:	US
Telephone Number	:	515-243-2412
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BERNARD LAWRENCE GRADOVILLE
Credential	:	D.D.S.
Telephone Number	:	515-243-2412

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	12/16/2021

Similar Medicare Providers

1619958600 — DR. BERNARD L. GRADOVILLE D.D.S.
Practice Location Address:

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1922007640 — JEFFREY JAMES HELLER D.C.
Practice Location Address:

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1124020805 — DR. RONALD STEVEN BERGMAN D.O.
Practice Location Address:

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Directions to “INGERSOLL FAMILY DENTISTRY ” Practice Location

Language	Start Address	Practice Location

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