MEDICARE: DR. NICHOLAS P KAMAKAS D.D.S.

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	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

General Provider Information

NPI Number	:	1023127107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS P KAMAKAS D.D.S.

Provider Business Mailing Address
First Line	:	3721 JENNINGS STATION RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-3505
Country	:	US
Telephone Number	:	314-382-2000
Fax Number	:	314-382-2411

Provider Business Practice Location Address
First Line	:	3721 JENNINGS STATION RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-3505
Country	:	US
Telephone Number	:	314-382-2000
Fax Number	:	314-382-2411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/24/2015

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Directions to “ DR. NICHOLAS P KAMAKAS D.D.S.” Practice Location

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