Provider Demographics
NPI:1205215837
Name:INGRAHAM, KRISTAN JOI (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:JOI
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3205
Mailing Address - Country:US
Mailing Address - Phone:203-722-3027
Mailing Address - Fax:
Practice Address - Street 1:1478 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5938
Practice Address - Country:US
Practice Address - Phone:203-307-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT119441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry