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
—
—
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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