Ingram Mall Dental Center, P.L.L.C.

Primary specialty

DentistTaxonomy code 122300000X

License

15889 Issued in TX

Legal business name

INGRAM MALL DENTAL CENTER, P.L.L.C.

Practice address

6301 NW Loop 410
L1A
San Antonio, TX 78238-3824

Phone

(210) 354-4867

Fax

(210) 681-6985

NPI assigned

Jan 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Bertha Elizabeth Rodriguez

Title

Regional Manager

Phone

(210) 354-4867

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263859200000",
    "number": "1043541741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 NW LOOP 410",
            "address_2": "L1A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782383824",
            "telephone_number": "210-354-4867",
            "fax_number": "210-681-6985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 NW LOOP 410",
            "address_2": "L1A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782383824",
            "telephone_number": "210-354-4867",
            "fax_number": "210-681-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGRAM MALL DENTAL CENTER, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-01-19",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "BERTHA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "210-354-4867",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "15889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosalinda Ingle, LVN
• Amanda L. Inglish, APRN, FNP-C
• Paul T Ingmundson, PH.D.
• Ingram Assisted Living LLC
• Ingram Hills Dental, PLLC
• Ingram Mall FDC PA
• Ingram Mall Fdcpa
• Alma Ingram Nlemadim
• Dennis Ingram
• George Steven Ingram, M.D.

• Dentist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.