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General NPI Number Information
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NPI Number | 1528668746
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Entity Type | Organization
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Legal Business Name | ANDREK J INGERSOLL DENTAL CORPORATION
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 2775 PARK MARINA DR STE A
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City | REDDING
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State | CA
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Zip | 96001-2840
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Country | US
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Telephone | 919-656-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 N TRIUMPH BLVD STE 100
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City | LEHI
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State | UT
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Zip | 84043-5046
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Country | US
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Telephone | 801-494-4949
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ANDY JEFFREY INGERSOLL
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Credential | DMD
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Telephone | 530-579-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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