Healthcare Provider Details

I. General information

NPI: 1467014365
Provider Name (Legal Business Name): ASHTON LESLIE RICHARDS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S STERLING AVE
SUGAR CREEK MO
64054-1215
US

IV. Provider business mailing address

104 S STERLING AVE
SUGAR CREEK MO
64054-1215
US

V. Phone/Fax

Practice location:
  • Phone: 816-447-7096
  • Fax:
Mailing address:
  • Phone: 816-254-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2018019107
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61445
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: