Individual provider Active NPI

Nefeli Vasilakou, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Saint Louis, MO
National Provider Identifier
1730434192
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
12012734A Issued in IN
Practice address
3320 Rutger Street
Saint Louis, MO 63104
Phone
(314) 977-8363
NPI assigned
Jul 20, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 0401416830 VA
Student in an Organized Health Care Education/Training Program 390200000X
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 12012734A IN Primary

Addresses

Primary practice location

3320 Rutger Street
Saint Louis, MO 63104

Mailing address

322 N Boyle Ave Apt 2N
Saint Louis, MO 63108
Phone (314) 665-9041

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
12012734AINMDOrthodontics and Dentofacial Orthopedic Dentist
0401416830VAMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1730434192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 N BOYLE AVE APT 2N",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63108",
            "telephone_number": "314-665-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 RUTGER STREET",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63104",
            "telephone_number": "314-977-8363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASILAKOU",
        "first_name": "NEFELI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "0401416830",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12012734A",
            "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 Feb 16, 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.