Provider Demographics
NPI:1043835648
Name:WILLIAMS, KELLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3162 S HANNIBAL ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1750
Mailing Address - Country:US
Mailing Address - Phone:719-588-3142
Mailing Address - Fax:
Practice Address - Street 1:3162 S HANNIBAL ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-1750
Practice Address - Country:US
Practice Address - Phone:719-588-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COT-DEN.00000026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist