Provider Demographics
NPI:1962429894
Name:INGHILTERRA, GIANNI S (DDS)
Entity type:Individual
Prefix:DR
First Name:GIANNI
Middle Name:S
Last Name:INGHILTERRA
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 1:1703 E VALLEY PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2500
Mailing Address - Country:US
Mailing Address - Phone:760-747-3388
Mailing Address - Fax:760-747-3780
Practice Address - Street 1:1703 E VALLEY PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2500
Practice Address - Country:US
Practice Address - Phone:760-747-3388
Practice Address - Fax:760-747-3780
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice