Individual
AMANDA WIEBKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
400 W BASELINE RD UNIT A, LAFAYETTE, CO 80026
(720) 319-7170
Mailing address
511 BIRDIE CT, ONALASKA, WI 54650
(608) 317-6481
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00206385
CO
Other
Enumeration date
06/18/2025
Last updated
06/18/2025
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