Dental Office of Andrek J Ingersoll

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DENTAL OFFICE OF ANDREK J INGERSOLL

Practice address

585 Tahoe Keys Blvd Ste 2
South Lake Tahoe, CA 96150-3371

Phone

(530) 541-3772

NPI assigned

Jan 13, 2025

Organization subpart

No

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

Authorized official

Name

Mrs. Leeann Blazer

Title

Director of Operations

Phone

(707) 673-7531

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin John Cassidy, DDS

  • Dentist
  • South Lake Tahoe, CA
  • NPI 1841393360
  NPD (past)

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1417767161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 TAHOE KEYS BLVD STE 2",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503371",
            "telephone_number": "530-541-3772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 TAHOE KEYS BLVD STE 2",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503371",
            "telephone_number": "530-541-3772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL OFFICE OF ANDREK J INGERSOLL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "BLAZER",
        "authorized_official_first_name": "LEEANN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "707-673-7531",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd William Degiovanni, PA-C
• Barbara D Delorenzo, MSW
• Aubrey Louise Demajh, M.D.
• Hillary Dembroff, OTR
• Joseph H Dengler, PT
• Desert Rose Obstetrics & Gynecology
• Elisabeth Dewees
• Holly Ann Dewitt, DACM
• Diagnostic Centers of America LLP
• Jerett Lewis Diamond

• Dental Clinic/Center in South Lake Tahoe, CA
• Providers in South Lake Tahoe, 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 Jan 13, 2025; 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.