Healthcare Provider Details

I. General information

NPI: 1588071120
Provider Name (Legal Business Name): AMY MICHELLE DESTAFFANY R.D.H., B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MICHELLE DESTAFFANY R.D.H., B.S.

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 S PARKER RD SUITE 202
AURORA CO
80014-1623
US

IV. Provider business mailing address

351 S DOWNING ST
DENVER CO
80209-2466
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-2290
  • Fax:
Mailing address:
  • Phone: 303-877-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.000903877
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: