STEPHEN BERTRAM INGRAM JR. (NPI# 1255842340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255842340 |
| Entity Type | Individual |
| Full Name | STEPHEN BERTRAM INGRAM JR. |
| Credential | DMD |
| Practice Address |
710 S 12th St Lebanon PA 17042-6901 |
| Mailing Address |
710 S 12th Street Lebanon PA 17042 |
| Practice Telephone | 7172742913 |
| Practice Fax Number | 7172740728 |
| Mailing Telephone | 7172742913 |
| Mailing Fax Number | 7172740728 |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
DS020047L | PA | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 921 S Forge Rd, Palmyra, PA 170783411 | 7178320738 | 7178323153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659780146 | Stephen Tyler Ingram | Physician Assistant | 1010 W 40th St, Austin, TX 78746 | 2014-08-08 |
| Street Address |
710 S 12TH ST |
| City | LEBANON |
| State | PA |
| Zip Code | 17042-6901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396870317 | Ingram and Daugherty Orthodontists, LLC | Dentist | 710 S 12th St, Lebanon, PA 17042-6901 | 2007-02-22 |
| 1831600113 | Warren Patrick Daugherty | Dentist | 710 S 12th St, Lebanon, PA 17042-6901 | 2017-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023676384 | Sandra L Pistone | Registered Nurse | 905 S. 2nd Ave, Lebanon, PA 17042 | 2019-06-03 |
| 1154848414 | Kihc, LLC | Home Health | 900-c Centerville Road, Suite C, Lancaster, PA 17042 | 2017-08-28 |
| 1316301724 | Good Samaritan Physician Services | Radiology | 844 Tuck Street, Lebanon, PA 17042 | 2016-04-12 |
| 1609265883 | Ashley Hess | Behavioral Analyst | 15th South 9th Street, Lebanon, PA 17042 | 2015-01-12 |
| 1932504727 | Anthony Salvadore Petrole | Physician Assistant | 252 4th Street, Lebanon, PA 17042 | 2014-10-23 |
| 1801209713 | Matthew Johnson | Family Medicine | 920 Church Street, Lebanon, PA 17042 | 2014-06-09 |
| 1437414505 | Odalys Gonzalez-rodriguez | Physical Therapist | 1700 S Lincoln Ave., Lebanon Vmac Bldg 102 Room 120, Lebanon, PA 17042 | 2012-07-05 |
| 1750677175 | Anita Lyn Stokes | Speech-Language Pathologist | 1126 Walnut Street, Lebanon, PA 17042 | 2011-06-23 |
| 1205126497 | Karey Lynn Foote | Pharmacist | 415 S. 9th St, Lebanon, PA 17042 | 2011-04-09 |
| 1013227685 | T. W. Ponessa and Associates Counseling Services, Inc. | Community/Behavioral Health | 101 E. Evergreen Road, Lebanon, PA 17042 | 2010-10-18 |
| Find all providers in zip 17042 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649650540 | Brice Gilliam | Dentist | 2737 Hickory Ridge Rd, Lebanon, TN 37087-5715 | 2015-06-05 |
| 1083833693 | Amy N Schulte | Dentist | 376 Sunset Dr, Lebanon, MO 65536-2069 | 2007-04-24 |
| 1538382858 | Thomas John Jaeger | Dentist | 1128 Route 31, Lebanon, NJ 08833 | 2007-04-11 |
| 1396870317 | Ingram and Daugherty Orthodontists, LLC | Dentist | 710 S 12th St, Lebanon, PA 17042-6901 | 2007-02-22 |
| 1194850024 | Robert G Wertz | Dentist | 855 Norman Dr, Lebanon, PA 17042-7445 | 2007-02-22 |
| 1679625123 | Barton Jay Girdwood | Dentist | 215 N Broadway St, Lebanon, OH 45036-1715 | 2007-01-17 |
| 1053337410 | Ross W Stryker | Dentist | 590 Lynn St, Lebanon, MO 65536-2409 | 2006-07-15 |
| 1831600113 | Warren Patrick Daugherty | Dentist | 710 S 12th St, Lebanon, PA 17042-6901 | 2017-10-13 |
| 1457861320 | Axpm - Merkley, LLC | Dentist | 590 Lynn St, Lebanon, MO 65536-2409 | 2017-10-05 |
| 1114297017 | Robert George Wertz Jr. | Dentist | 855 Norman Dr, Lebanon, PA 17042-7445 | 2012-01-09 |
| Find all providers in LEBANON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.