ANDREKGBORTHO INGERSOLL DENTAL CORPORATION
NPI 1356216907
Dentist - Orthodontics and Dentofacial Orthopedics in Granite Bay, CA

Active since October 06, 2025
4150 DOUGLAS BLVD STE B, GRANITE BAY, CA 95746(916) 774-6986 Get Directions Write a Review

NPPES record last updated: October 6, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Andrekgbortho Ingersoll Dental Corporation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREKGBORTHO INGERSOLL DENTAL CORPORATION (NPI 1356216907) is a healthcare organization registered as an orthodontics and dentofacial orthopedics in Granite Bay, California and active in the NPI registry since October 2025. The organization lists Leeann Blazer, Director Of Operations, as its authorized official.

NPPES Registry Identity

NPI1356216907
Entity TypeOrganization
Primary Taxonomy1223X0400X
Legal Business NameANDREKGBORTHO INGERSOLL DENTAL CORPORATION
Location Address4150 DOUGLAS BLVD STE BGranite Bay, CA 95746-5908
Mailing Address3300 N Triumph Blvd Ste 100Lehi, UT 84043-5046 · (707) 673-7531
Organization SubpartNo
Authorized OfficialLeeann BlazerDirector Of Operations · (707) 673-7531
Enumeration DateOctober 6, 2025
NPPES CertifiedOctober 6, 2025
NPI 1356216907 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
Definition

That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.

4150 DOUGLAS BLVD STE B, Granite Bay, CA 95746

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dentist (Orthodontics and Dentofacial Orthopedics)
4150 DOUGLAS BLVD STE B
GRANITE BAY, CA 95746
Dentist (Orthodontics and Dentofacial Orthopedics)
4150 DOUGLAS BLVD STE B
GRANITE BAY, CA 95746

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1356216907, enumerated as an "organization" on October 06, 2025.

The provider is located at 4150 DOUGLAS BLVD STE B GRANITE BAY, CA 95746 and the phone number is (916) 774-6986.

Dentist with taxonomy code 1223X0400X and a focus in Orthodontics and Dentofacial Orthopedics.