Provider Demographics
NPI:1942546072
Name:O'SHEA, INGA KEITHLY (DMD)
Entity type:Individual
Prefix:
First Name:INGA
Middle Name:KEITHLY
Last Name:O'SHEA
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:NMRTC LEMOORE
Mailing Address - Street 2:937 FRANKLIN AVENUE
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:93245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:937 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93246-4700
Practice Address - Country:US
Practice Address - Phone:559-998-4215
Practice Address - Fax:559-998-4262
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8447979-9921122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist