Provider Demographics
NPI:1558314724
Name:TOOTHMAN, INGRID K (DMD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:K
Last Name:TOOTHMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6812
Practice Address - Street 1:1006 MAIN STREET
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:PA
Practice Address - Zip Code:15475
Practice Address - Country:US
Practice Address - Phone:724-246-9434
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022876L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist