Richard James Nissen, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

014094 Issued in MO

Practice address

31 The Boulevard-St. Louis
Saint Louis, MO 63117

Phone

(314) 727-6162

Fax

(314) 727-7259

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1215046008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 THE BOULEVARD-ST. LOUIS",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63117",
            "telephone_number": "314-727-6162",
            "fax_number": "314-727-7259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 THE BOULEVARD-ST. LOUIS",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63117",
            "telephone_number": "314-727-6162",
            "fax_number": "314-727-7259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "RICHARD",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MO",
            "license": "14094",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MO",
            "license": "014094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "14094",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richa Niraula, M.D.
• Nirvana Healthcare Plus LLC
• Omar Nisar, MD
• Ronald Glennon Nisbet Jr., D.C.
• Pallavi Mishra Nishith, PH.D, LP
• Stephanie D Nissen, RN, ACNP-BC
• Andrea Nissenbaum
• Arthur H Nissenbaum, LPC
• Sylvia Nissenboim, LCSW
• Matthew H Nissing, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.