Provider Demographics
NPI:1750402251
Name:ANTHONY CODISPOTI, D.D.S., STEFANIE CAIN NIKODEM, D.D.S., L.L.C.
Entity type:Organization
Organization Name:ANTHONY CODISPOTI, D.D.S., STEFANIE CAIN NIKODEM, D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN NIKODEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-493-9457
Mailing Address - Street 1:4565 DRESSLER RD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2549
Mailing Address - Country:US
Mailing Address - Phone:330-493-9457
Mailing Address - Fax:330-493-8898
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2549
Practice Address - Country:US
Practice Address - Phone:330-493-9457
Practice Address - Fax:330-493-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty