Provider Demographics
NPI:1053946913
Name:BOATENG, AMA ASIEDUWAA
Entity type:Individual
Prefix:DR
First Name:AMA
Middle Name:ASIEDUWAA
Last Name:BOATENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 E BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1158
Mailing Address - Country:US
Mailing Address - Phone:443-838-6615
Mailing Address - Fax:
Practice Address - Street 1:2044 CLINTON ST UNIT B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1003
Practice Address - Country:US
Practice Address - Phone:646-406-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002042771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice