Provider Demographics
NPI:1376704718
Name:AMELANG-SEVERIN, AMBER D (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:D
Last Name:AMELANG-SEVERIN
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 E PROSPECT RD UNIT B1
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1367
Mailing Address - Country:US
Mailing Address - Phone:970-482-4916
Mailing Address - Fax:970-221-5424
Practice Address - Street 1:1331 E PROSPECT RD UNIT B1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1367
Practice Address - Country:US
Practice Address - Phone:970-482-4916
Practice Address - Fax:970-221-5424
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics