Individual
DR. RYAN NIKODEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1121 W GANNON DR, FESTUS, MO 63028-2602
(636) 937-9133
Mailing address
10635 FOREST LAWN CT, SAINT LOUIS, MO 63128-1549
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2015015766
MO
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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