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General NPI Number Information
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NPI Number | 1164372090
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Entity Type | Organization
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Legal Business Name | ANDREK FRORTHO INGERSOLL DENTAL CORPORATION
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 1473 LIVE OAK BLVD
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City | YUBA CITY
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State | CA
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Zip | 95991-2920
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Country | US
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Telephone | 530-441-2452
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Fax |
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Provider Business Mailing Address
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Address Line | 1473 LIVE OAK BLVD
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City | YUBA CITY
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State | CA
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Zip | 95991-2920
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Country | US
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Telephone | 530-441-2452
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | STACY KINGREY
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Credential |
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Telephone | 530-356-4685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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