Peter Douglas Ingoldsby, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

62870 Issued in CA

Practice address

4881 Sugar Maple Dr
Wright Patterson Afb, OH 45433-5529

Phone

(937) 257-9588

NPI assigned

Feb 14, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 28, 2024 through Jun 28, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jon R. Ewig, DDS, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Beavercreek, OH
  • NPI 1982650560
  NPD (past)
• Miami Valley Oral Surgery and Dental Implants LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Beavercreek, OH
  • NPI 1174393060
  NPD (past)

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

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524182400000",
    "number": "1225377054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 N WAYTE LN",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012124",
            "telephone_number": "559-459-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGOLDSBY",
        "first_name": "PETER",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-14",
        "last_updated": "2018-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62870",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "62870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Michael Howell, PHYSICIAN ASSISTANT
• Mark Edward Hubner, MD
• Kermit David Huebner, M.D.
• Carla Huelskamp, PHARMD
• Eirleen Young-Ju Hyun, DMD
• Andrea Irons, MSW, LISW
• Keith Janda
• Susan Elizabeth Jefferson I, PHARMACIST
• Joseph Edward Johnson, D.M.D
• Latasha J Johnson, PA-C

• Oral and Maxillofacial Surgery (Dentist) in Wright Patterson Afb, OH
• Providers in Wright Patterson Afb, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.