Healthcare Provider Details

I. General information

NPI: 1811836133
Provider Name (Legal Business Name): ANDREK REDORTHO INGERSOLL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 BECHELLI LN STE E
REDDING CA
96002-0119
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 100
LEHI UT
84043-5046
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-0460
  • Fax:
Mailing address:
  • Phone: 707-673-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LEEANN BLAZER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 707-673-7531