Provider Demographics
NPI:1699854729
Name:INGRAM, WILLIAM L (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:INGRAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 DRAKE AVE SW
Mailing Address - Street 2:STE 10-B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5199
Mailing Address - Country:US
Mailing Address - Phone:256-883-7832
Mailing Address - Fax:256-882-6629
Practice Address - Street 1:2227 DRAKE AVE SW
Practice Address - Street 2:STE 10-B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5199
Practice Address - Country:US
Practice Address - Phone:256-883-7832
Practice Address - Fax:256-882-6629
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice