Stephen Bertram Ingram Jr., DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DS020047L Issued in PA

Practice address

710 S 12TH St
Lebanon, PA 17042-6901

Phone

(717) 274-2913

Fax

(717) 274-0728

NPI assigned

Oct 17, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Ingram and Daugherty Orthodontists, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lebanon, PA
  • NPI 1396870317
  NPD (past) Authorized official

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1255842340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S 12TH STREET",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "17042",
            "telephone_number": "717-274-2913",
            "fax_number": "717-274-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S 12TH ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170426901",
            "telephone_number": "717-274-2913",
            "fax_number": "717-274-0728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 S Forge Rd",
            "address_purpose": "LOCATION",
            "city": "Palmyra",
            "state": "PA",
            "postal_code": "170783411",
            "country_code": "US",
            "telephone_number": "717-832-0738",
            "fax_number": "717-832-3153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "STEPHEN",
        "middle_name": "BERTRAM",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "DS020047L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Rebecca Illyes, LCSW
• Paul Impellizzeri, M.D.
• Independence Corporation
• Individual Empowerment Inc
• Ingram and Daugherty Orthodontists, LLC
• Innovative Wellness Group LLC
• Melanie Erin Isaac, MT-BC
• Michael Jeffrey Itzkowitz, PH.D.
• Mark Jacobson, DO
• James Dale Streiff

• Orthodontics and Dentofacial Orthopedics Dentistry in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.