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Organization
INGERSOLL KNOLLCREST OS DENTAL CORPORATION
Active
Organization
INGERSOLL KNOLLCREST OS DENTAL CORPORATION
Active
Other names
Riverside Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREK JEFFREY INGERSOLL DMD (MANAGER)
(919) 656-3004
Entity
Organization
Contact information
Practice address
316 KNOLLCREST DR, REDDING, CA 96002-0104
(919) 656-3004
Mailing address
3300 N TRIUMPH BLVD STE 100, LEHI, UT 84043-5046
(801) 494-4949
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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