Andrek Rosortho Ingersoll Dental Corporation

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

ANDREK ROSORTHO INGERSOLL DENTAL CORPORATION

Practice address

1431 Secret Ravine Pkwy # 151
Roseville, CA 95661-4051

Phone

(916) 782-3161

NPI assigned

Sep 8, 2025

Last updated

Sep 8, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Leeann Blazer

Title

Director of Operations

Phone

(707) 673-7531

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757289600000",
    "number": "1760363832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 SECRET RAVINE PKWY # 151",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614051",
            "telephone_number": "916-782-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 SECRET RAVINE PKWY # 151",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614051",
            "telephone_number": "916-782-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREK ROSORTHO INGERSOLL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-08",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "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"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Roseville, CA
• Providers in Roseville, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.