Provider Demographics
NPI:1689985509
Name:INGERSOLL, ANDREK J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREK
Middle Name:J
Last Name:INGERSOLL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5768
Mailing Address - Country:US
Mailing Address - Phone:402-972-8374
Mailing Address - Fax:
Practice Address - Street 1:1852 DESERT PEACH DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8321
Practice Address - Country:US
Practice Address - Phone:919-656-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1054961223P0221X
UT5653994-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry