# INGERSOLL KNOLLCREST OS DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Riverside Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215537444
- **Authorized official:** DR. ANDREK JEFFREY INGERSOLL DMD (MANAGER)
- **Authorized official phone:** (919) 656-3004

## Contact information

- **Practice address:** 316 KNOLLCREST DR, REDDING, CA 96002-0104
- **Practice address phone:** (919) 656-3004
- **Mailing address:** 3300 N TRIUMPH BLVD STE 100, LEHI, UT 84043-5046
- **Mailing address phone:** (801) 494-4949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2020
- **Last updated:** 10/27/2020