Richard James Nissen, DDS, MS Valid NPI
Individual provider · Orthodontics and Dentofacial Orthopedics Dentistry · Saint Louis, MO
- NPI
- 1215046008
- Type
- Individual (Type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223X0400X
- License number
- 014094 (MO)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2006-08-29
- Last updated
- 2019-04-16
Practice location
31 The Boulevard-St. Louis
Saint Louis, MO 63117
(314) 727-6162