Healthcare Provider Details

I. General information

NPI: 1194832741
Provider Name (Legal Business Name): HIGHLINE FAMILY DENTRISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W DRY CREEK CIR #125
LITTLETON CO
80120
US

IV. Provider business mailing address

2 W DRY CREEK CIR #125
LITTLETON CO
80120
US

V. Phone/Fax

Practice location:
  • Phone: 303-794-6800
  • Fax: 303-794-1148
Mailing address:
  • Phone: 303-794-6800
  • Fax: 303-794-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number8491
License Number StateCO

VIII. Authorized Official

Name: DR. AMY LYNNE BECKER
Title or Position: OWNER
Credential: DDS
Phone: 303-794-6800