Provider Demographics
NPI:1326168949
Name:INGRAM, LENORE SM (DDS)
Entity Type:Individual
Prefix:MISS
First Name:LENORE
Middle Name:SM
Last Name:INGRAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HARRISON AVE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5359
Mailing Address - Country:US
Mailing Address - Phone:360-754-9300
Mailing Address - Fax:360-754-0220
Practice Address - Street 1:1415 HARRISON AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5359
Practice Address - Country:US
Practice Address - Phone:360-754-9300
Practice Address - Fax:360-754-0220
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist