Provider Demographics
NPI:1871910240
Name:SYMES, INGRID (RDH)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:SYMES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 PONY HILLS PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6086
Mailing Address - Country:US
Mailing Address - Phone:505-350-3162
Mailing Address - Fax:
Practice Address - Street 1:8105 PONY HILLS PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6086
Practice Address - Country:US
Practice Address - Phone:505-350-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2196124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist