Provider Demographics
NPI:1063137834
Name:NIKRODHANOND, APIS (PHDH, RDH)
Entity type:Individual
Prefix:
First Name:APIS
Middle Name:
Last Name:NIKRODHANOND
Suffix:
Gender:F
Credentials:PHDH, RDH
Other - Prefix:
Other - First Name:APISCHAYA
Other - Middle Name:
Other - Last Name:NIKRODHANOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2002
Mailing Address - Country:US
Mailing Address - Phone:708-508-0227
Mailing Address - Fax:
Practice Address - Street 1:1106 NEAL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2548
Practice Address - Country:US
Practice Address - Phone:815-727-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.013083125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist