Healthcare Provider Details

I. General information

NPI: 1821135823
Provider Name (Legal Business Name): ZACHARY NICHOLAS SOIYA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 JENNINGS STATION RD
SAINT LOUIS MO
63121-3500
US

IV. Provider business mailing address

2515 CAPTIVA DR APT 10
SAINT LOUIS MO
63125-5616
US

V. Phone/Fax

Practice location:
  • Phone: 314-382-2000
  • Fax: 314-382-2411
Mailing address:
  • Phone: 708-337-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19-17894
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2019038311
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: