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General NPI Number Information
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NPI Number | 1477210805
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Entity Type | Individual
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Provider Name | KELLI LYN EMMANS-ORT RDH
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 223 HARRISON AVE
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City | LEADVILLE
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State | CO
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Zip | 80461-3392
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Country | US
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Telephone | 970-668-4043
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Fax |
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Provider Business Mailing Address
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Address Line | 218 E 8TH ST
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City | LEADVILLE
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State | CO
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Zip | 80461-3137
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Country | US
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Telephone | 386-576-3780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH002024634
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State | CO
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