Raymond Gerard Nikodem, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

014792 Issued in MO

Practice address

4337 Butler Hill Rd
Saint Louis, MO 63128-3735

Phone

(314) 892-2000

Fax

(314) 892-4550

NPI assigned

Feb 27, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Custom Dental Management

  • General Practice Dentistry
  • Saint Louis, MO
  • NPI 1427920461
  NPD Authorized official
• MDP of Missouri LLC

  • General Practice Dentistry
  • Hazelwood, MO
  • NPI 1356202378
  NPD (past)

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740317098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4337 BUTLER HILL RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283735",
            "telephone_number": "314-892-2000",
            "fax_number": "314-892-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4337 BUTLER HILL RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283735",
            "telephone_number": "314-892-2000",
            "fax_number": "314-892-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKODEM",
        "first_name": "RAYMOND",
        "middle_name": "GERARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "014792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikodem Dental Holdings, Inc.
• Nikodem Dental Holdings, Inc.
• Nikodem Dental Holdings, Inc.
• Keith Andrew Nikodem, DDS
• Luke Andrew Nikodem, DDS
• Stephen Gerard Nikodem, DDS,.MS
• Stephen Mark Nikodem, DDS
• Jamie Louise Nilson, RD
• Pascal Nilsson, MD
• Praveen Srisatya Nimmagadda, MD

• Dentist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.