Healthcare Provider Details

I. General information

NPI: 1063993327
Provider Name (Legal Business Name): ZACHARY VAUGHN ZYLSTRA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W 44TH AVE STE 200
DENVER CO
80212-7339
US

IV. Provider business mailing address

5600 W 44TH AVE STE 200
DENVER CO
80212-7339
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-0063
  • Fax: 720-907-1485
Mailing address:
  • Phone: 203-421-0063
  • Fax: 720-907-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00206548
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: