Provider Demographics
NPI:1851968663
Name:CLARKSON, EMILY PAIGE (RDH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:PAIGE
Last Name:CLARKSON
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 1:100 S MAPLE AVE UNIT 14
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-8103
Mailing Address - Country:US
Mailing Address - Phone:970-405-8223
Mailing Address - Fax:
Practice Address - Street 1:4745 E BOARDWALK DR.
Practice Address - Street 2:BUILDING C SUITE 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-405-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024882124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist