Ingersoll Park Marina GP Dental Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

INGERSOLL PARK MARINA GP DENTAL CORPORATION

Doing business as

Riverbend Family Dental

Practice address

2301 Park Marina Dr Ste 27
Redding, CA 96001-2158

Phone

(801) 494-4949

NPI assigned

Oct 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrek Jeffrey Ingersoll, DMD

Title

Manager

Phone

(919) 656-3004

Specialties & licenses 1

Addresses

Other names 1

• Riverbend Family Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1316547524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 N TRIUMPH BLVD STE 100",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840435046",
            "telephone_number": "801-494-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 PARK MARINA DR STE 27",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960012158",
            "telephone_number": "801-494-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGERSOLL PARK MARINA GP DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "INGERSOLL",
        "authorized_official_first_name": "ANDREK",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "919-656-3004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverbend Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Redding, CA
• Providers in Redding, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.