Provider Demographics
NPI:1275141095
Name:SWISHER, LUXI
Entity Type:Individual
Prefix:
First Name:LUXI
Middle Name:
Last Name:SWISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 APPLE VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4725
Mailing Address - Country:US
Mailing Address - Phone:816-331-4200
Mailing Address - Fax:
Practice Address - Street 1:109 APPLE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-4725
Practice Address - Country:US
Practice Address - Phone:816-892-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230134251223G0001X
KS61643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist