Healthcare Provider Details

I. General information

NPI: 1063993327
Provider Name (Legal Business Name): ZACHARY VAUGHN ZYLSTRA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14620 HUEBNER RD
SAN ANTONIO TX
78230-5429
US

IV. Provider business mailing address

14620 HUEBNER RD
SAN ANTONIO TX
78230-5429
US

V. Phone/Fax

Practice location:
  • Phone: 210-697-7377
  • Fax:
Mailing address:
  • Phone: 210-697-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: