Provider Demographics
NPI:1699251165
Name:RISTOW, LUKE ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:ANTHONY
Last Name:RISTOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21812 W 97TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-3740
Mailing Address - Country:US
Mailing Address - Phone:573-999-7138
Mailing Address - Fax:
Practice Address - Street 1:930 IOWA ST STE 1
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1869
Practice Address - Country:US
Practice Address - Phone:573-999-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS614671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice