Provider Demographics
NPI:1770922783
Name:COLEBECK, AMANDA C (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:C
Last Name:COLEBECK
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:DEPT OF ORAL ONCOLOGY AND MAXILLOFACIAL PROSTHETICS
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-1736
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DEPT OF ORAL ONCOLOGY AND MAXILLOFACIAL PROSTHETICS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:171-689-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0566321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics