Individual
DR. ERICA R KETCHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3568 SW MARKET ST, LEES SUMMIT, MO 64082
(816) 537-6161
(816) 537-6165
Mailing address
3568 SW MARKET ST, LEES SUMMIT, MO 64082-2327
(816) 537-6161
(816) 537-6165
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2007019130
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
05/22/2018
Last updated
06/21/2018
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