Healthcare Provider Details

I. General information

NPI: 1932124104
Provider Name (Legal Business Name): MYRON ZALUCKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 UPPER HAVENSIGHT MALL SUITE #309
ST THOMAS VI
00802-2666
US

IV. Provider business mailing address

9003 UPPER HAVENSIGHT MALL SUITE #309
ST THOMAS VI
00802-2666
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-5050
  • Fax: 340-777-9170
Mailing address:
  • Phone: 340-776-5050
  • Fax: 340-777-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number557
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: