1245324060 NPI number — DR. MARK ROBERT ZUST DDS

Table of content: DR. MARK ROBERT ZUST DDS (NPI 1245324060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245324060 NPI number — DR. MARK ROBERT ZUST DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUST
Provider First Name:
MARK
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245324060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 4 SEASONS SHOPPING CTR
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-928-1100
Provider Business Mailing Address Fax Number:
636-928-1292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 GAILWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-6581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-928-1100
Provider Business Practice Location Address Fax Number:
636-928-1292
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12123 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)