Provider Demographics
NPI:1528034691
Name:INGALLS, GREGORY KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KENT
Last Name:INGALLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5371 S GENEVA WAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6222
Mailing Address - Country:US
Mailing Address - Phone:303-290-6440
Mailing Address - Fax:
Practice Address - Street 1:8025 CLUB CREST DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-2269
Practice Address - Country:US
Practice Address - Phone:303-431-0033
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery