Healthcare Provider Details

I. General information

NPI: 1124959218
Provider Name (Legal Business Name): ZACHARY RULON TROST DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 N 25TH E STE 201
IDAHO FALLS ID
83401-1051
US

IV. Provider business mailing address

2454 N 25TH E STE 201
IDAHO FALLS ID
83401-1051
US

V. Phone/Fax

Practice location:
  • Phone: 208-612-6100
  • Fax:
Mailing address:
  • Phone: 208-612-6100
  • Fax: 208-612-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5381712
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: