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General NPI Number Information
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NPI Number | 1811836133
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Entity Type | Organization
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Legal Business Name | ANDREK REDORTHO INGERSOLL DENTAL CORPORATION
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 2315 BECHELLI LN STE E
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City | REDDING
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State | CA
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Zip | 96002-0119
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Country | US
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Telephone | 530-223-0460
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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 | 707-673-7531
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | LEEANN BLAZER
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Credential |
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Telephone | 707-673-7531
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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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