Healthcare Provider Details

I. General information

NPI: 1427188960
Provider Name (Legal Business Name): GARY DEAN ZUCK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 ROSEWOOD DR
PRAIRIE VILLAGE KS
66208-5008
US

IV. Provider business mailing address

8132 ROSEWOOD DR
PRAIRIE VILLAGE KS
66208-5008
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-5261
  • Fax:
Mailing address:
  • Phone: 913-648-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberKS4570
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: