Organization
INGRAM AND DAUGHERTY ORTHODONTISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN B INGRAM DMD, CERT ORTHODONT (ORTHODONTIST)
(717) 274-2913
Entity
Organization
Contact information
Practice address
710 S 12TH ST, LEBANON, PA 17042-6901
(717) 274-2913
Mailing address
710 S 12TH ST, LEBANON, PA 17042-6901
(717) 274-2913
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS020047L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS020047L
DR INGRAMS STATE LICENSE
PA
Enumeration date
02/22/2007
Last updated
08/22/2020
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