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General NPI Number Information
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NPI Number | 1093109571
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Entity Type | Individual
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Provider Name | MAZEN Y SULTAN DMD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 4133 MEXICO ROAD
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City | ST. PETERS
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State | MO
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Zip | 63376
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Country | US
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Telephone | 636-447-6060
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Fax | 636-447-2428
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Provider Business Mailing Address
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Address Line | 4133 MEXICO ROAD
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City | ST. PETERS
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State | MO
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Zip | 63376
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Country | US
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Telephone | 636-447-6060
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Fax | 636-447-2428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9620
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License Number State | KY
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