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MARK M INGRAM DMD
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1982758223
Individual Registrant: MARK M INGRAM DMD
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
1407 E UNION ST VIENNA, GA 31092-7531 US
Tel: 229-268-6079 Fax: --
Tel: 229-268-6079 Fax: --
Contact information for business:
1407 E UNION ST VIENNA, GA 31092-7531 US
Tel: 229-268-6079 Fax: --
Tel: 229-268-6079 Fax: --
Registration Information:
NPI: 1982758223
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | GA | 9355 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
