Provider Demographics
NPI:1922099969
Name:INGLE, ROBERT VINSANT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINSANT
Last Name:INGLE
Suffix:JR
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 1:523 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-4169
Mailing Address - Country:US
Mailing Address - Phone:865-984-8595
Mailing Address - Fax:
Practice Address - Street 1:1944 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5284
Practice Address - Country:US
Practice Address - Phone:865-984-8595
Practice Address - Fax:865-980-5594
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9178874Medicare ID - Type UnspecifiedTENNCARE