Healthcare Provider Details

I. General information

NPI: 1811960818
Provider Name (Legal Business Name): PETER ZAGURSKY JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD SUITE 600
SAINT LOUIS MO
63141-6345
US

IV. Provider business mailing address

3521 SMITHVILLE DR
DUNKIRK MD
20754-9665
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-3982
  • Fax: 877-685-9866
Mailing address:
  • Phone: 410-286-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10766
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: