Healthcare Provider Details

I. General information

NPI: 1962000505
Provider Name (Legal Business Name): ENRICH DENTAL SC SERIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
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: 816-254-6557
  • Fax: 816-254-6550
Mailing address:
  • Phone: 816-254-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ASHTON LESLIE RICHARDS
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 816-447-7096