Provider Demographics
NPI:1487424420
Name:BANTHO, AMISHKA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMISHKA
Middle Name:
Last Name:BANTHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 CYAN CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3937
Mailing Address - Country:US
Mailing Address - Phone:719-725-8583
Mailing Address - Fax:
Practice Address - Street 1:9871 S PARKER RD UNIT 105
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8802
Practice Address - Country:US
Practice Address - Phone:303-805-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002058291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice