Provider Demographics
NPI:1588071120
Name:DESTAFFANY, AMY MICHELLE (RDH, BS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:DESTAFFANY
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:DESTAFFANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, BS
Mailing Address - Street 1:351 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2466
Mailing Address - Country:US
Mailing Address - Phone:303-877-6308
Mailing Address - Fax:
Practice Address - Street 1:2530 S PARKER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1623
Practice Address - Country:US
Practice Address - Phone:303-750-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000903877124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist