Provider Demographics
NPI:1639313752
Name:RICKY D. POWELL, D.D.S., LLC
Entity Type:Organization
Organization Name:RICKY D. POWELL, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:DARYL
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-882-6452
Mailing Address - Street 1:1945 BOONE VILLA DR
Mailing Address - Street 2:B
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-2050
Mailing Address - Country:US
Mailing Address - Phone:660-882-6452
Mailing Address - Fax:
Practice Address - Street 1:1945 BOONE VILLA DR
Practice Address - Street 2:B
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-2050
Practice Address - Country:US
Practice Address - Phone:660-882-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty