Provider Demographics
NPI:1205215837
Name:INGRAHAM-MCQUEEN, KRISTAN JOI (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:JOI
Last Name:INGRAHAM-MCQUEEN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11128 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-3890
Mailing Address - Country:US
Mailing Address - Phone:203-722-3027
Mailing Address - Fax:
Practice Address - Street 1:10040 US HIGHWAY 301 N STE A
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8493
Practice Address - Country:US
Practice Address - Phone:914-229-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT119441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry