Provider Demographics
NPI:1356232490
Name:NIKODEM, LUKE ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ANDREW
Last Name:NIKODEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 FRONTENAC FRST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-3220
Mailing Address - Country:US
Mailing Address - Phone:314-402-8334
Mailing Address - Fax:
Practice Address - Street 1:4337 BUTLER HILL RD STE G
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3735
Practice Address - Country:US
Practice Address - Phone:314-892-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250288761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice