Dakoda Apodaca-Johnson
Individual provider Active NPI Dentist · Arnold, MO
NPI 1609484112 · NPPES record last updated Jul 21, 2020
Key facts
- NPI
- 1609484112
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2020020659 (MO)
- Practice address
- 3540 Jeffco Blvd Ste 110
Arnold, MO 63010-3999 - Phone
- (636) 461-0933
- NPI assigned
- Jul 21, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250724003461 | MO | Order and Referring Only - Dentist |
3173030236 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020020659 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Dental Professionals, Richard Straus, DMD, PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2020020659 | MO | Yes |
Addresses
Primary practice location
3540 Jeffco Blvd Ste 110
Arnold, MO 63010-3999
Mailing address
3540 Jeffco Blvd Ste 110
Arnold, MO 63010-3999
Phone (636) 461-0933
Other providers in Arnold, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.