Provider Demographics
NPI:1265553846
Name:INGRAHAM, GABRIEL BUCHANAN III (DMD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:BUCHANAN
Last Name:INGRAHAM
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:108 SOUTH CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1403
Mailing Address - Country:US
Mailing Address - Phone:803-475-9440
Mailing Address - Fax:803-475-3927
Practice Address - Street 1:108 SOUTH CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1403
Practice Address - Country:US
Practice Address - Phone:803-475-9440
Practice Address - Fax:803-475-3927
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1940122300000X
SC2421223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0700XDental ProvidersDentistProsthodontics