Provider Demographics
NPI:1487860128
Name:INGALLS, BRIAN KENT (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENT
Last Name:INGALLS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42000 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4336
Mailing Address - Country:US
Mailing Address - Phone:248-305-9380
Mailing Address - Fax:248-305-5239
Practice Address - Street 1:42000 6 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4336
Practice Address - Country:US
Practice Address - Phone:248-305-9380
Practice Address - Fax:248-305-5239
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0131611223X0400X
ALD.0006721-C1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics