Healthcare Provider Details

I. General information

NPI: 1891485819
Provider Name (Legal Business Name): LYDIA NICOLE RYKARD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N BALLAS RD STE 245
SAINT LOUIS MO
63131-2378
US

IV. Provider business mailing address

2821 N BALLAS RD STE 245
SAINT LOUIS MO
63131-2378
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2025020237
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: