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General NPI Number Information
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NPI Number | 1881711083
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Entity Type | Organization
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Legal Business Name | GARYDEANZUCK, DDS,PA
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4121 W 83RD ST SUITE 200
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5300
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Country | US
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Telephone | 913-381-2400
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Fax | 913-381-2564
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Provider Business Mailing Address
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Address Line | 4121 W 83RD ST SUITE 200
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5300
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Country | US
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Telephone | 913-381-2400
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Fax | 913-381-2564
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY DEAN ZUCK
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Credential | DDS
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Telephone | 913-381-2400
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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 | 4570
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License Number State | KS
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