Provider Demographics
NPI:1558720367
Name:WALTEMEYER, AMANDA RACHEL (RDH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHEL
Last Name:WALTEMEYER
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 1:16830 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5778
Mailing Address - Country:US
Mailing Address - Phone:720-261-6282
Mailing Address - Fax:
Practice Address - Street 1:16830 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5778
Practice Address - Country:US
Practice Address - Phone:720-261-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000905431124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist