Healthcare Provider Details

I. General information

NPI: 1871275172
Provider Name (Legal Business Name): LADIJAH IMANI SHIVERS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 47TH ST
KANSAS CITY MO
64112-1377
US

IV. Provider business mailing address

PO BOX 2
ELKHORN NE
68022-0002
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-2191
  • Fax:
Mailing address:
  • Phone: 405-772-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2026011892
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7969
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: