Individual
DR. RICHARD JAMES NISSEN
Active
Individual
DR. RICHARD JAMES NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
014094
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
14094
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14094
STATE LICENSE
MO
Enumeration date
08/29/2006
Last updated
04/16/2019
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