Provider Demographics
NPI:1306230446
Name:ANDREAS, AMANDA MARIE (RDH)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:ANDREAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 W DRAKE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2881
Mailing Address - Country:US
Mailing Address - Phone:970-223-1166
Mailing Address - Fax:
Practice Address - Street 1:373 W DRAKE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2881
Practice Address - Country:US
Practice Address - Phone:970-223-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002023672124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist