Provider Demographics
NPI:1114138146
Name:INGRACE DENTAL CLINIC, PLC
Entity Type:Organization
Organization Name:INGRACE DENTAL CLINIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NNENNA
Authorized Official - Middle Name:NWANYIRIUBA
Authorized Official - Last Name:EBODA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:810-230-9800
Mailing Address - Street 1:2222 S LINDEN RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5475
Mailing Address - Country:US
Mailing Address - Phone:810-230-9802
Mailing Address - Fax:
Practice Address - Street 1:2222 S LINDEN RD
Practice Address - Street 2:SUITE K
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5475
Practice Address - Country:US
Practice Address - Phone:810-230-9802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty