Healthcare Provider Details

I. General information

NPI: 1992154355
Provider Name (Legal Business Name): ALEXIS NICOLE RICKEL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E MEYER BLVD STE 200
KANSAS CITY MO
64132-1121
US

IV. Provider business mailing address

2340 E MEYER BLVD STE 200
KANSAS CITY MO
64132-1121
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-5144
  • Fax:
Mailing address:
  • Phone: 816-682-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2021013067
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61151
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: