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General NPI Number Information
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NPI Number | 1962000505
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Entity Type | Organization
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Legal Business Name | ENRICH DENTAL SC SERIES LLC
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 104 S STERLING AVE
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City | SUGAR CREEK
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State | MO
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Zip | 64054-1215
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Country | US
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Telephone | 816-254-6557
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Fax | 816-254-6550
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Provider Business Mailing Address
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Address Line | 104 S STERLING AVE
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City | SUGAR CREEK
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State | MO
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Zip | 64054-1215
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Country | US
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Telephone | 816-254-6557
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | ASHTON LESLIE RICHARDS
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Credential | DDS
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Telephone | 816-447-7096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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