Healthcare Provider Details

I. General information

NPI: 1891822524
Provider Name (Legal Business Name): JULIA RACHELE LOECKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 SW EAGLES PARKWAY
GRAIN VALLEY MO
64029
US

IV. Provider business mailing address

1424 SW EAGLES PKWY
GRAIN VALLEY MO
64029-8508
US

V. Phone/Fax

Practice location:
  • Phone: 816-847-8222
  • Fax: 816-847-8088
Mailing address:
  • Phone: 816-847-8222
  • Fax: 816-847-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number015710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: