Provider Demographics
NPI:1215642830
Name:AMEN, KARLIE
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:AMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 BUENA VISTA BLVD UNIT 17
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2664
Mailing Address - Country:US
Mailing Address - Phone:702-960-8751
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST STE 205
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6458
Practice Address - Country:US
Practice Address - Phone:435-652-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13173398-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist