Healthcare Provider Details

I. General information

NPI: 1699607820
Provider Name (Legal Business Name): AMANDA WILLIAMS RDH, OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST STE C1
FORT COLLINS CO
80526-1830
US

IV. Provider business mailing address

215 6TH ST PO BOX 362
WINDSOR CO
80550-0362
US

V. Phone/Fax

Practice location:
  • Phone: 303-960-9000
  • Fax:
Mailing address:
  • Phone: 303-960-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002024031
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: