Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN18998 | FL |
NPI | 1003186529 |
---|---|
Provider Name | Christopher Michael Ingalls |
First Address | Lake Mary, FL 32746-6746 |
Second Address | Lake Mary, FL 32746-6746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2012 |
Last Update Date | 25/09/2012 |