Nicholas Jon Wilsdorf, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2023023194 Issued in MO

Practice address

2653 Locust St
Saint Louis, MO 63103-1411

Phone

(314) 645-6451

NPI assigned

Jun 20, 2023

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: nwilsdorf650512@direct.ochin.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 20, 2023.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1679258263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 OAK KNOLL RD",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014714",
            "telephone_number": "573-201-4732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2653 LOCUST ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031411",
            "telephone_number": "314-645-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSDORF",
        "first_name": "NICHOLAS",
        "middle_name": "JON",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2023023194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Michele Wilmas, MD
• Jacob Michael Wilmes, PMHNP-BC
• Wilmington Chiropractic Clinic, LLC
• Wilmington Clinic D.C., P.C.
• Tara Wilmot, RDN, LD
• Vanessa Wilson-Cox
• Scott Andrew Wilson-Flewelling, MD
• Alexandra Erin Wilson, BS, ATC
• Alexandria Noelle Wilson, PT, DPT, ATC
• Amy Renee Wilson, PSY.D.

• All providers in Saint Louis, MO
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.