Healthcare Provider Details

I. General information

NPI: 1992815062
Provider Name (Legal Business Name): DAVID EDWARD DYKHOUSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SOUTH OUTER RD
BLUE SPRINGS MO
64015
US

IV. Provider business mailing address

1300 SOUTH OUTER RD
BLUE SPRINGS MO
64015
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-0444
  • Fax: 816-228-8199
Mailing address:
  • Phone: 816-229-0444
  • Fax: 816-228-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number015919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: