MEDICARE: DR. ZACHARY SCOTT PICKUP DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	40486	TX

General Provider Information

NPI Number	:	1194568881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY SCOTT PICKUP DMD

Provider Business Mailing Address
First Line	:	5406 ESPIRTU SANTO DR
Second Line	:
City	:	BELTON
State	:	TX
Zip	:	76513-2283
Country	:	US
Telephone Number	:	208-260-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 HEIGHTS DR STE 2
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2185
Country	:	US
Telephone Number	:	254-870-3221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/25/2024

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