Provider Demographics
NPI:1750482196
Name:INGALLS, DONALD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:INGALLS
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 1:7200 HALCYON SUMMIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7047
Mailing Address - Country:US
Mailing Address - Phone:334-277-3492
Mailing Address - Fax:334-277-9432
Practice Address - Street 1:7200 HALCYON SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7047
Practice Address - Country:US
Practice Address - Phone:334-277-3492
Practice Address - Fax:334-277-9432
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51549686OtherBCBS OF ALABAMA
AL000090871Medicaid
AL009983320Medicaid
AL790598OtherUNITED CONCORDIA
AL51090871OtherBCBS OF ALABAMA
ALU01023Medicare UPIN
AL000090871Medicaid
AL000090871Medicaid