Provider Demographics
NPI:1194425090
Name:AMANDA VANDERSTELT, DMD, PLLC
Entity type:Organization
Organization Name:AMANDA VANDERSTELT, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERSTELT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:502-797-5380
Mailing Address - Street 1:574 EAGLE NEST CT
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-0907
Mailing Address - Country:US
Mailing Address - Phone:502-797-5380
Mailing Address - Fax:
Practice Address - Street 1:1215 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1537
Practice Address - Country:US
Practice Address - Phone:303-521-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental