Individual
AMANDA MARIE LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 E STEWART AVE BLDG 2018, PETERSON AFB, CO 80914-2900
(719) 556-1333
Mailing address
5055 SODBUSTER TRL, COLORADO SPRINGS, CO 80917-1715
(406) 868-0180
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
01/22/2021
Last updated
01/22/2021
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