Provider Demographics
NPI:1427786896
Name:KREITEL, AMANDA (RDH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KREITEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 SPRUCEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3619
Mailing Address - Country:US
Mailing Address - Phone:907-385-7694
Mailing Address - Fax:
Practice Address - Street 1:515 SPRUCEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3619
Practice Address - Country:US
Practice Address - Phone:907-385-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK148098124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist