Healthcare Provider Details

I. General information

NPI: 1134536733
Provider Name (Legal Business Name): AMANDA K. POOLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 DRY CREEK DR STE 304
LONGMONT CO
80503-7751
US

IV. Provider business mailing address

1325 DRY CREEK DR STE 304
LONGMONT CO
80503-7751
US

V. Phone/Fax

Practice location:
  • Phone: 720-763-8876
  • Fax:
Mailing address:
  • Phone: 720-763-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00203810
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: