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NPI Code Detail

MEDICARE: DR. VICTORIA DZUNDZEV D.M.D.

MEDICARE: DR. VICTORIA DZUNDZEV D.M.D.
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
11223G0001XGeneral Practice Dentistry015366MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2015366OTHERMOMO LICENSE NUMBER

General Provider Information

NPI Number : 1356489561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VICTORIA DZUNDZEV D.M.D.
Provider Business Mailing Address
First Line : 141 N MERAMEC AVE STE 14
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-3750
Country : US
Telephone Number : 314-862-2006
Fax Number :
Provider Business Practice Location Address
First Line : 6121 N HANLEY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-0500
Fax Number : 314-615-8303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 05/09/2013

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