Aqua Ingram PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AQUA INGRAM PLLC

Practice address

6064 Ingram Rd
San Antonio, TX 78238-4402

Phone

(972) 677-7845

NPI assigned

Oct 6, 2011

Organization subpart

No

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

Authorized official

Name

Antonio Rivera

Title

Managing Member

Phone

(972) 677-7845

Specialties & licenses 2

Addresses

Other names 1

• Aqua Dental Ingram Doing business as

Locations

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1942584040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6064 INGRAM RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782384402",
            "telephone_number": "972-677-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6064 INGRAM RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782384402",
            "telephone_number": "972-677-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUA INGRAM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "972-677-7845"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aqua Dental Ingram",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; 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.