NPIMap

Organization Active NPI

Nikodem Dental Holdings

Doing business as Nikodem Dental Care

  • General Practice Dentistry
  • St Louis Mo, MO
National Provider Identifier
1326504655
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NIKODEM DENTAL HOLDINGS
Doing business as
Nikodem Dental Care
Practice address
4337 Butler Hill Rd Suite G
St Louis Mo, MO 63128
Phone
(314) 892-2000
Fax
(314) 892-4550
NPI assigned
Feb 12, 2019
Organization subpart
Yes
Parent organization
NIKODEM DENTAL HOLDINGSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Authorized official

Name
Dr. Raymond G Nikodem, DDS
Title
President
Phone
(314) 732-4591

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4337 Butler Hill Rd Suite G
St Louis Mo, MO 63128

Mailing address

4337 Butler Hill Rd Suite L
St Louis, MO 63128
Phone (314) 732-4591

Other names 1

  • Nikodem Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nikodem Dental Holdings Inc9 organizations share this tax ID, including this one
Part of
Nikodem Dental Holdings Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4337 Butler Hill Rd
Ste G
Saint Louis, MO 63128
Phone (314) 892-2000

NPI Registry JSON

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549929600000",
    "number": "1326504655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4337 BUTLER HILL RD SUITE L",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-732-4591",
            "fax_number": "314-200-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4337 BUTLER HILL RD SUITE G",
            "city": "ST LOUIS MO",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-892-2000",
            "fax_number": "314-892-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIKODEM DENTAL HOLDINGS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NIKODEM DENTAL HOLDINGS",
        "enumeration_date": "2019-02-12",
        "last_updated": "2019-02-12",
        "status": "A",
        "authorized_official_last_name": "NIKODEM",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-732-4591",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nikodem Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis Mo, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.