Provider Demographics
NPI:1487488060
Name:DR ANDREK GV INGERSOLL DENTAL CORPORATION
Entity type:Organization
Organization Name:DR ANDREK GV INGERSOLL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREK
Authorized Official - Middle Name:
Authorized Official - Last Name:INGERSOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-656-3004
Mailing Address - Street 1:115 W EMPIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7510
Mailing Address - Country:US
Mailing Address - Phone:530-478-8366
Mailing Address - Fax:
Practice Address - Street 1:115 W EMPIRE ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7510
Practice Address - Country:US
Practice Address - Phone:530-478-8366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty