Provider Demographics
NPI:1295942431
Name:RICHARD L. INGRAHAM, DDS, MS, PA
Entity type:Organization
Organization Name:RICHARD L. INGRAHAM, DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:INGRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:361-992-4746
Mailing Address - Street 1:5525 S STAPLES ST STE C
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5366
Mailing Address - Country:US
Mailing Address - Phone:361-992-4746
Mailing Address - Fax:
Practice Address - Street 1:5525 S STAPLES ST STE C
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5366
Practice Address - Country:US
Practice Address - Phone:361-992-4746
Practice Address - Fax:361-992-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty