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NPI Code Detail

MEDICARE: AMANDA DICRISTINA RDH

MEDICARE: AMANDA DICRISTINA RDH
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
1124Q00000XDental Hygienist002023627CO

General Provider Information

NPI Number : 1831577964
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DICRISTINA RDH
Provider Business Mailing Address
First Line : 4123 HALF MOON CIR
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-6021
Country : US
Telephone Number : 720-220-4183
Fax Number :
Provider Business Practice Location Address
First Line : 1815 JET WING DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-2300
Country : US
Telephone Number : 719-632-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2015
Last Update Date : 09/13/2023

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