Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Andrekgbortho Ingersoll Dental Corporation

Organization Orthodontics and Dentofacial Orthopedics Dentistry · NPI 1356216907

Andrekgbortho Ingersoll Dental Corporation is an Orthodontics and Dentofacial Orthopedics Dentistry in Granite Bay, California. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

4150 Douglas Blvd Ste B
Granite Bay, CA 95746-5908
Phone: (916) 774-6986
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthodontics and Dentofacial Orthopedics Dentistry (primary) Taxonomy 1223X0400X

Record details

NPI number1356216907
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Leeann Blazer — Director Of Operations · (707) 673-7531
NPI enumeratedOctober 6, 2025
Last updated in NPPESOctober 6, 2025
Certification dateOctober 6, 2025
Mailing address3300 N Triumph Blvd Ste 100, Lehi, UT 84043-5046

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