Organization
ANDREK ROSORTHO 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
1431 SECRET RAVINE PKWY # 151, ROSEVILLE, CA 95661-4051
(916) 782-3161
Mailing address
1431 SECRET RAVINE PKWY # 151, ROSEVILLE, CA 95661-4051
(916) 782-3161
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
09/08/2025
Last updated
09/08/2025
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