Provider Demographics
NPI:1538136106
Name:GINGRASS, DAVID J (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GINGRASS
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 1:2323 NORTH MAYFAIR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1506
Mailing Address - Country:US
Mailing Address - Phone:414-257-1161
Mailing Address - Fax:414-257-0194
Practice Address - Street 1:2323 NORTH MAYFAIR RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1506
Practice Address - Country:US
Practice Address - Phone:414-257-1161
Practice Address - Fax:414-257-0194
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS0016160151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33540900Medicaid
WI33540900Medicaid
WI778250004Medicare ID - Type Unspecified