MEDICARE: DR. ZACHARY NICHOLAS SOIYA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19-17894	IL
2	122300000X	Dentist	2019038311	MO

General Provider Information

NPI Number	:	1821135823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY NICHOLAS SOIYA D.D.S.

Provider Business Mailing Address
First Line	:	2515 CAPTIVA DR APT 10
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-5616
Country	:	US
Telephone Number	:	708-337-6473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 JENNINGS STATION RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-3500
Country	:	US
Telephone Number	:	314-382-2000
Fax Number	:	314-382-2411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	10/21/2022

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