Individual
KELLY INGRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0002
(507) 284-2339
Mailing address
PO BOX 860912, PROVIDER ENROLLMENT - RST, MINNEAPOLIS, MN 55486-0912
(507) 584-2511
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
D14374
MN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D14374
MN
Other
Enumeration date
03/31/2020
Last updated
01/28/2025
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