Provider Demographics
NPI:1104637321
Name:INGRAM, DAKOTA ALAN
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:ALAN
Last Name:INGRAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:74534-5204
Mailing Address - Country:US
Mailing Address - Phone:580-258-0811
Mailing Address - Fax:
Practice Address - Street 1:1697 S GREATHOUSE DR
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3407
Practice Address - Country:US
Practice Address - Phone:580-889-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist