Organization
ANDREKGBORTHO INGERSOLL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEEANN BLAZER (DIRECTOR OF OPERATIONS)
(707) 673-7531
Entity
Organization
Contact information
Practice address
4150 DOUGLAS BLVD STE B, GRANITE BAY, CA 95746-5908
(916) 774-6986
Mailing address
3300 N TRIUMPH BLVD STE 100, LEHI, UT 84043-5046
(707) 673-7531
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
10/06/2025
Last updated
10/06/2025
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