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General NPI Number Information
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NPI Number | 1811960818
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Entity Type | Individual
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Provider Name | PETER ZAGURSKY JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12647 OLIVE BLVD SUITE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6345
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Country | US
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Telephone | 800-325-3982
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Fax | 877-685-9866
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Provider Business Mailing Address
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Address Line | 3521 SMITHVILLE DR
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City | DUNKIRK
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State | MD
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Zip | 20754-9665
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Country | US
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Telephone | 410-286-8799
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10766
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License Number State | MD
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