Individual
KELLI LYN EMMANS-ORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
223 HARRISON AVE, LEADVILLE, CO 80461-3392
(970) 668-4043
Mailing address
218 E 8TH ST, LEADVILLE, CO 80461-3137
(386) 576-3780
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
DH002024634
—
124Q00000X
Dental Hygienist
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10001110101
—
CO
Enumeration date
11/19/2021
Last updated
11/19/2021
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