Provider Demographics
NPI:1982739249
Name:INGRAM, RICHARD A (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:INGRAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S 2000 W
Mailing Address - Street 2:F 1
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-776-3000
Mailing Address - Fax:801-825-7700
Practice Address - Street 1:780 S 2000 W
Practice Address - Street 2:F 1
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9602
Practice Address - Country:US
Practice Address - Phone:801-776-3000
Practice Address - Fax:801-825-7700
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6240726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist