INGERSOLL KNOLLCREST OS DENTAL CORPORATION (NPI# 1215537444) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215537444 |
| Entity Type | Organization |
| Organization Name | INGERSOLL KNOLLCREST OS DENTAL CORPORATION |
| Practice Address |
316 Knollcrest Dr Redding CA 96002-0104 |
| Mailing Address |
3300 N Triumph Blvd Ste 100 Lehi UT 84043-5046 |
| Practice Telephone | 9196563004 |
| Mailing Telephone | 8014944949 |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | DR. ANDREK JEFFREY INGERSOLL (MANAGER) |
| Authorized Official Telephone | 9196563004 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Riverside Oral Surgery | Doing Business As Name - Organization |
| Street Address |
316 KNOLLCREST DR |
| City | REDDING |
| State | CA |
| Zip Code | 96002-0104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497817191 | Daniel W Petersen | Dentist | 316 Knollcrest Dr, Redding, CA 96002-0104 | 2006-12-16 |
| 1649677915 | Daniel Petersen Dds, Inc. | Oral & Maxillofacial Surgery | 316 Knollcrest Dr, Redding, CA 96002-0104 | 2014-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265048037 | Daniel Eli Bartee | Counselor | 555 Leila Ave #44, Redding, CA 96002 | 2020-09-17 |
| 1407467129 | Drake Exstrom | Dentist | 2315 North Bechelli Ln, Suite A, Redding, CA 96002 | 2020-08-14 |
| 1285123117 | Victor Treatment Centers, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 20846 Clairvaux Drive, Redding, CA 96002 | 2018-05-07 |
| 1528510153 | Daniel Conklin | Pharmacist | 2880 Churn Creek, Redding, CA 96002 | 2016-10-31 |
| 1740653864 | Votc, Inc. | Substance Abuse Rehabilitation Facility | 3590 El Portal Dr., # 7, 8, 9, 10, 15, 16, & 17, Redding, CA 96002 | 2015-11-11 |
| 1801226253 | Katie Marie Mccullough-stubbs | Marriage & Family Therapist | 3300 Church Creek, Redding, CA 96002 | 2013-11-21 |
| 1801234026 | Kathy Lynne Hawk | Community Health Worker | 2051 Hilltop Dr A-13, Redding, CA 96002 | 2013-06-10 |
| 1619247590 | Wright Education Services | Social Worker | 2660 Victor Ave, Redding, CA 96002 | 2012-01-09 |
| 1275828840 | Shannika Tricia Dao | Dentist | 2695 Bechelli Ln, Redding, CA 96002 | 2011-06-13 |
| 1336442664 | Small Talk Pediatric Services, Inc. | Speech-Language Pathologist | 2526 Goodwater Ave., Suite A, Redding, CA 96002 | 2010-12-08 |
| Find all providers in zip 96002 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538493317 | Richard A. Look, D.d.s., Inc. | Dentist | 2710 Eureka Way Ste 3, Redding, CA 96001-0230 | 2009-09-25 |
| 1669551164 | Mark Cox | Dentist | 2945 Northwoods Way, Redding, CA 96002-2136 | 2006-11-03 |
| 1740387422 | William Walker Evans | Dentist | 2710 Eureka Way, Suite 3, Redding, CA 96001-0230 | 2006-09-17 |
| 1225274442 | Daniel Petersen, Dds, Inc. | Dentist | 2315 Bechelli Ln, Suite A, Redding, CA 96002-0119 | 2008-12-17 |
| 1619169521 | Terrance A. Rust, D.d.s., Inc. | Dentist | 2315 Bechelli Ln, Suite A, Redding, CA 96002-0119 | 2007-08-14 |
| 1144384595 | Terrance A Rust | Dentist | 2315 Bechelli Ln, Suite A, Redding, CA 96002-0119 | 2006-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807979 | Ayed Hawatmeh Dds Inc | Dentist | 322 E Foothill Blvd, Pomona, CA 91767 | 2020-10-02 |
| 1114533064 | Alexander V. Antipov, D.d.s., Inc. | Dentist | 911 Reserve Drive, Suite 150, Roseville, CA 95678 | 2020-09-16 |
| 1609493170 | Amir Haghshenas Dds | Dentist | 3880 S Bascom Ave Ste 213, San Jose, CA 95124-2675 | 2020-07-01 |
| 1316568900 | Beech & Reid Dental Partnership | Dentist | 464 E Calaveras Blvd Ste B3, Milpitas, CA 95035-5412 | 2020-05-05 |
| 1518506773 | Francisco Suarez, Dds Inc. | Dentist | 4606 Hollywood Blvd Ste A, Los Angeles, CA 90027-5462 | 2020-01-04 |
| 1831748839 | Slate Dental Corporation | Dentist | 6512 Lonetree Blvd Ste 100, Rocklin, CA 95765-5883 | 2019-09-11 |
| 1255980140 | Dr Maloux Macasaet Saguin Dental Corporation | Dentist | 9800 Topanga Canyon Blvd Ste J, Chatsworth, CA 91311-4075 | 2019-09-04 |
| 1891342267 | Amrollahie and Riman Dental Partnership | Dentist | 1442 Irvine Blvd Ste 225, Tustin, CA 92780-3846 | 2019-08-21 |
| 1548821572 | Hoang Dental Corporation | Dentist | 1356 W Valley Pkwy Ste J, Escondido, CA 92029-2138 | 2019-06-20 |
| 1073173860 | Omfs Care Center Partners | Dentist | 215 N Fresno St Ste 490, Fresno, CA 93701-0000 | 2019-06-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.