Provider Demographics
NPI:1144407651
Name:INGERSOLL, ALAN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:INGERSOLL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-0573
Mailing Address - Country:US
Mailing Address - Phone:801-225-1179
Mailing Address - Fax:801-225-0085
Practice Address - Street 1:75 W 400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4729
Practice Address - Country:US
Practice Address - Phone:801-225-1179
Practice Address - Fax:801-225-0085
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138355-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice