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General NPI Number Information
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NPI Number | 1639263460
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Entity Type | Organization
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Legal Business Name | MARK R ZUST DDS LTD
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 80 GAILWOOD DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-6581
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Country | US
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Telephone | 636-928-1100
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Fax | 636-928-1292
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Provider Business Mailing Address
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Address Line | 36 4 SEASONS SHOPPING CTR # 300
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3103
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Country | US
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Telephone | 636-928-1100
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Fax | 636-928-1292
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK R ZUST
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Credential | DDS
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Telephone | 636-928-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12123
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License Number State | MO
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