Individual provider Active NPI

Stephen Mark Nikodem, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Saint Louis, MO
National Provider Identifier
1306541305
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
2023021406 Issued in MO
Practice address
4116 Von Talge Rd Ste a
Saint Louis, MO 63128-1957
Phone
(314) 894-1311
NPI assigned
Mar 31, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 2023021406 MO Primary

Addresses

Primary practice location

4116 Von Talge Rd Ste a
Saint Louis, MO 63128-1957

Mailing address

134 Frontenac FRST
Saint Louis, MO 63131-3220
Phone (314) 402-1168

Other practice location 1

1119 W Gannon Dr
Festus, MO 63028-2602
Phone (636) 931-4233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN123946GAMDGeneral Practice Dentistry
2023021406MOMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Stephen G. Nikodem DDS Ms PC Orthodontics and Dentofacial Orthopedics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1306541305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 FRONTENAC FRST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631313220",
            "telephone_number": "314-402-1168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 VON TALGE RD STE A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631281957",
            "telephone_number": "314-894-1311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1119 W Gannon Dr",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630282602",
            "country_code": "US",
            "telephone_number": "636-931-4233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIKODEM",
        "first_name": "STEPHEN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-31",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MO",
            "license": "2023021406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; 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.