Provider Demographics
NPI:1962553362
Name:INGERMAN, EDWARD FRED (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRED
Last Name:INGERMAN
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 1:19 HYDER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3722
Mailing Address - Country:US
Mailing Address - Phone:508-366-0759
Mailing Address - Fax:
Practice Address - Street 1:530 BOSTON POST RD E STE D
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3645
Practice Address - Country:US
Practice Address - Phone:508-481-8094
Practice Address - Fax:508-481-8478
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice