Provider Demographics
NPI:1770833287
Name:GRACEY, AMBER LYNN (RDH)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:GRACEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1423
Mailing Address - Country:US
Mailing Address - Phone:970-241-1313
Mailing Address - Fax:970-241-5202
Practice Address - Street 1:2333 N 6TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-298-1782
Practice Address - Fax:970-692-8301
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906574124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist