Provider Demographics
NPI:1427075381
Name:TINGEY, IAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:C
Last Name:TINGEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1925
Mailing Address - Country:US
Mailing Address - Phone:860-678-7528
Mailing Address - Fax:860-678-7933
Practice Address - Street 1:291 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1925
Practice Address - Country:US
Practice Address - Phone:860-678-7528
Practice Address - Fax:860-678-7933
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2070621Medicaid
T22355Medicare UPIN