Nikodem Dental Care

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2014015546 Issued in MO

Legal business name

NIKODEM DENTAL CARE

Practice address

811 Hazelwest Dr
Hazelwood, MO 63042-1749

Phone

(314) 731-7555

Fax

(314) 731-7562

NPI assigned

Sep 16, 2014

Organization subpart

No

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

Authorized official

Name

Charles Daniel Hurley, DDS

Title

Dentist

Phone

(314) 731-7555

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1902207426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 HAZELWEST DR",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421749",
            "telephone_number": "314-731-7555",
            "fax_number": "314-731-7562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 HAZELWEST DR",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421749",
            "telephone_number": "314-731-7555",
            "fax_number": "314-731-7562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIKODEM DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-16",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "314-731-7555",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2014015546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Puja Manchira Natesan, MD
• Nicholas Nazzoli, MA, BCBA
• Wilson Gachugu Ndungu, NP
• Judy A. Neal
• Jessica C Nieva, DDS
• Nikodem Dental Holdings, Inc. (Nikodem Dental Hazelwood)
• A R Norman, BCBA
• Guilan Norouzi, DDS
• North County Chiropractic & Rehab, LLC
• North County in Home Healthcare LLC

• Dental Clinic/Center in Hazelwood, MO
• Providers in Hazelwood, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.