MEDICARE: LUKE ANTHONY RISTOW DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	61467	KS

General Provider Information

NPI Number	:	1699251165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE ANTHONY RISTOW DDS

Provider Business Mailing Address
First Line	:	21812 W 97TH TER
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66220-3740
Country	:	US
Telephone Number	:	573-999-7138
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 IOWA ST STE 1
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66044-1869
Country	:	US
Telephone Number	:	573-999-7138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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