Healthcare Provider Details

I. General information

NPI: 1588785596
Provider Name (Legal Business Name): STEPHEN M. ZOBRIST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W. RAILROAD AVE
SUMMIT MS
39666
US

IV. Provider business mailing address

6943 JEFFERSON HWY
BATON ROUGE LA
70806-8110
US

V. Phone/Fax

Practice location:
  • Phone: 601-276-6330
  • Fax: 601-276-2556
Mailing address:
  • Phone: 225-248-6777
  • Fax: 225-927-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3317
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: