MEDICARE: NICHOLAS P KAMAKAS, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	010913	MO
2	1223G0001X	General Practice Dentistry	12839	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396918140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS P KAMAKAS, DDS

Provider Business Mailing Address
First Line	:	1167 REMLEY CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2135
Country	:	US
Telephone Number	:	314-727-7435
Fax Number	:	314-727-7003

Provider Business Practice Location Address
First Line	:	1167 REMLEY CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2135
Country	:	US
Telephone Number	:	314-727-7435
Fax Number	:	314-727-7003

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS P KAMAKAS
Credential	:
Telephone Number	:	314-727-7435

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	03/24/2015

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