Provider Demographics
NPI:1003186529
Name:INGALLS, CHRISTOPHER MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:INGALLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6746
Mailing Address - Country:US
Mailing Address - Phone:407-324-2090
Mailing Address - Fax:407-688-2612
Practice Address - Street 1:245 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6746
Practice Address - Country:US
Practice Address - Phone:407-324-2090
Practice Address - Fax:407-688-2612
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry