Healthcare Provider Details

I. General information

NPI: 1811682321
Provider Name (Legal Business Name): AMANDA FENSTERMAKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 WASHINGTON ST STE 203
THORNTON CO
80229-4537
US

IV. Provider business mailing address

1735 S PUBLIC RD STE 203
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 720-929-1655
  • Fax: 720-565-4129
Mailing address:
  • Phone: 303-665-3036
  • Fax: 303-665-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002026667
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: