Organization
CUSTOM DENTAL MANAGEMENT
Active
Parent organization
NIKODEM DENTAL HOLDINGS, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
NIKODEM DENTAL HOLDINGS, INC.
Authorized official
RAYMOND NIKODEM DR (OWNER)
(314) 288-2727
Entity
Organization
Contact information
Practice address
4337 BUTLER HILL RD STE G, SAINT LOUIS, MO 63128-3735
(314) 892-2000
Mailing address
331 N NEW BALLAS RD, SAINT LOUIS, MO 63141-5502
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/19/2025
Last updated
09/29/2025
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