Provider Demographics
NPI:1780367920
Name:INGALSBE, GREGORY RYAN
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RYAN
Last Name:INGALSBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 VINE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-2586
Mailing Address - Country:US
Mailing Address - Phone:484-661-7193
Mailing Address - Fax:
Practice Address - Street 1:4000 E CAMPUS LOOP S
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-1530
Practice Address - Country:US
Practice Address - Phone:402-472-1333
Practice Address - Fax:402-472-1225
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice