Provider Demographics
NPI:1881767200
Name:INGBER, JEFFREY S (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:INGBER
Suffix:
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 1:4664 W WALTON
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329
Mailing Address - Country:US
Mailing Address - Phone:248-674-0418
Mailing Address - Fax:248-674-4518
Practice Address - Street 1:4664 W WALTON
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329
Practice Address - Country:US
Practice Address - Phone:248-674-0418
Practice Address - Fax:248-674-4518
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9846122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124004993Medicaid
MIMI3899Medicare PIN