Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 008111 | CT |
NPI | 1164624409 |
---|---|
Provider Name | Dr. David Allen Ingber |
First Address | Westport, CT 06880-3948 |
Second Address | Westport, CT 06880-2422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |