Provider Demographics
NPI:1831577964
Name:DICRISTINA, AMANDA (RDH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DICRISTINA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4123 HALF MOON CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-6021
Mailing Address - Country:US
Mailing Address - Phone:720-220-4183
Mailing Address - Fax:
Practice Address - Street 1:1815 JET WING DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2300
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002023627124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist