Active NPI
Clark Joseph Ingoldsby, D.D.S.
- General Practice Dentistry
- Braintree, MA
National Provider Identifier
1740313402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14079
- Practice address
- 10 Forbes Rd
Suite 230
Braintree, MA 02184-2605 - Phone
- (781) 843-7905
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14079 | MA | Primary |
Addresses
Primary practice location
10 Forbes Rd
Suite 230
Braintree, MA 02184-2605
Mailing address
10 Forbes Rd
Suite 230
Braintree, MA 02184-2605
Phone (781) 843-7905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14079 | MA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Steven Bergman, DMD & Clark Ingoldsby, DDS, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Periodontics
- Braintree, MA
- NPI 1093744674
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740313402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 FORBES RD",
"address_2": "SUITE 230",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "021842605",
"telephone_number": "781-843-7905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 FORBES RD",
"address_2": "SUITE 230",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "021842605",
"telephone_number": "781-843-7905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGOLDSBY",
"first_name": "CLARK",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "14079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Braintree, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.