Dr Andrek Granped Ingersoll Dental Corporation

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

DR ANDREK GRANPED INGERSOLL DENTAL CORPORATION

Practice address

4150 Douglas Blvd Ste B
Granite Bay, CA 95746-5908

Phone

(916) 797-0931

NPI assigned

Feb 4, 2026

Organization subpart

No

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

Authorized official

Name

Stacy Kingrey, KINGREY

Title

Regional Manager

Phone

(530) 356-4685

Specialties & licenses 1

Addresses

Other names 1

• Bear Hollow Kids Dentistry - Granite Bay Doing business as

Locations

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

{
    "created_epoch": "1770163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1740131010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 DOUGLAS BLVD STE B",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957465908",
            "telephone_number": "916-797-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 DOUGLAS BLVD STE B",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957465908",
            "telephone_number": "916-797-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ANDREK GRANPED INGERSOLL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-04",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "KINGREY",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "530-356-4685",
        "authorized_official_credential": "KINGREY"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Hollow Kids Dentistry - Granite Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Discovery Practice Management, Inc
• Discovery Practice Management, Inc.
• Faith Caryn Doll
• Audreana Dolson
• Tricia Donnahoe
• Breanah Drake
• Sanh Duong
• Linda Earls, RPH
• Michelle Ebeling
• James Michael Elias, RPH

• Pediatric Dentistry in Granite Bay, CA
• Providers in Granite Bay, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; 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.