Provider Demographics
NPI:1275940686
Name:INGRAM, TARHONDA LEAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARHONDA
Middle Name:LEAH
Last Name:INGRAM
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 1:1061 HARMON AVE
Mailing Address - Street 2:US ARMY DENTAL HEALTH ACTIVITY
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-7006
Mailing Address - Fax:
Practice Address - Street 1:112 VILSECK ROAD, BLDG. 419-2
Practice Address - Street 2:
Practice Address - City:FT. STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315
Practice Address - Country:US
Practice Address - Phone:912-257-7056
Practice Address - Fax:912-257-7055
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist