Individual
CLIVE C INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
780 S 2000 W, F 1, SYRACUSE, UT 84075-9602
(801) 776-3000
(801) 825-7700
Mailing address
780 S 2000 W, F 1, SYRACUSE, UT 84075-9602
(801) 776-3000
(801) 825-7700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1349649922
UT
Other
Enumeration date
02/22/2007
Last updated
07/08/2007
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