Healthcare Provider Details

I. General information

NPI: 1275141095
Provider Name (Legal Business Name): LUXI SWISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 APPLE VALLEY PKWY
BELTON MO
64012-4725
US

IV. Provider business mailing address

109 APPLE VALLEY PKWY
BELTON MO
64012-4725
US

V. Phone/Fax

Practice location:
  • Phone: 816-892-5173
  • Fax:
Mailing address:
  • Phone: 816-331-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61643
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2023013425
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: