Amanda Marie Leak

NPI #1093305146 in Peterson Afb, Colorado

Provider Information

NPI Number: 1093305146
Entity Type: Individual
Name: Amanda Marie Leak
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Enumeration Date: Jan 22, 2021
Last Updated: Jan 22, 2021

Practice Location

Address: 1055 E STEWART AVE BLDG 2018
City: Peterson Afb
State: Colorado
ZIP Code: 80914-2900
Phone: (719) 556-1333

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Assistant	126800000X	Primary

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