MEDICARE: AMANDA T HALLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DEN.00204374	CO

General Provider Information

NPI Number	:	1720541675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA T HALLER DDS

Provider Business Mailing Address
First Line	:	6523 WHISTLE BAY DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-6294
Country	:	US
Telephone Number	:	563-209-8695
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 CONSTITUTION AVE STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-8903
Country	:	US
Telephone Number	:	719-596-9668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	11/15/2025

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