Provider Demographics
NPI:1518128958
Name:INGRAHAM, RICHARD L (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 S STAPLES ST STE C
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5366
Mailing Address - Country:US
Mailing Address - Phone:361-992-4746
Mailing Address - Fax:
Practice Address - Street 1:5525 S STAPLES ST STE C
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5366
Practice Address - Country:US
Practice Address - Phone:361-992-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics