Healthcare Provider Details

I. General information

NPI: 1083532568
Provider Name (Legal Business Name): AMBER EVE MANOLAKAS DENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER EVE PITTMAN

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S REDWOOD RD
SALT LAKE CITY UT
84104-5112
US

IV. Provider business mailing address

32 O ST
SALT LAKE CITY UT
84103-3905
US

V. Phone/Fax

Practice location:
  • Phone: 727-735-8385
  • Fax:
Mailing address:
  • Phone: 727-735-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12047277-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: